Mantle cell lymphoma may occasionally transform into a large grade lymphoma (MCL), a change referred to as blastic or blastoid transformation.

During the process of transformation, it is possible to see 2 populations of cells:

(1) small, round lymphocytes in a nodular pattern with a mature chromatin pattern that are CD20 positive with dim CD5 membrane staining

(2) large lymphocytes with frequent mitoses and diffuse growth that are CD20 positive but without CD5 staining


Clinical significance: after transformation the lymphoma tends to have a very aggressive course.


Predictive factors:

(1) leukocytosis

(2) elevated serum LDH activity

(3) high proliferative active based on mitotic count and Ki-67 staining

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