Figure 1 touch preparation and morphology
Giemsa stain (top left image) of touch imprint showing numerous pleomorphic moderate to large lymphoid cells with distinct nucleoli similar to those described in H&E sections.
H&E stain (top right image) of low power view of lymph node showing diffuse effacement in architecture of node with a vague nodular appearance.
H&E stain (bottom left image) of high power view of lymph node showing sheets of pleomorphic moderate to large lymphoid cells with convoluted nuclear membrane, clumped dispersed chromatin with single prominent central eosinophilic nucleoli. Also note mitosis in the center of field.
Pleomorphic cytomorphology also has an adverse prognosis.
Figure 2 Immunostains CD20, CD3, CD5
CD20 immunostain (top left image) of high power view showing pleomorphic lymphoid cells positive for CD20 indicating B cell lineage.
CD3 immunostain (top right image) of high power view showing CD3 positive scattered T cells. The pleomorphic lymphoma cells are CD3 negative.
CD5 immunostain (bottom left image) of high power view showing lymphoma cells positive for CD5. There are more CD5 positive cells compared to CD3 indicating that many CD5+ cells correspond to lymphomatous B cells.
Figure 3 Immunostains LEF1, cyclin D1, Ki67, p53, bcl2
LEF1 immunostain (top left image) at high power view showing lack of staining for LEF1 in lymphoma cells. The positive staining for LEF1 is seen in the scattered normal T cells present in the center of the field.
Cyclin D1 immunostain (top right image) at high power view showing positive staining in numerous pleomorphic lymphoid cells confirming the diagnosis of Mantle Cell Lymphoma.
Ki67 immunostain (middle left image) at high power view showing 30-40% proliferation index.
P53 immunostain (middle right image) at high power view showing positive nuclear staining in all lymphoma cells.
BCL2 immunostain (bottom left image) at high power view showing positive staining in lympoma cells.
