Blastoid Mantle Cell Lymphoma With Cutaneous Involvement and Aberrant Immunophenotype

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To the Editors:
We read with interest the case report titled “Primary cutaneous mantle cell lymphoma of the leg with blastoid morphology and aberrant immunophenotype: a diagnostic challenge” published recently in this journal.1 We strongly support the conclusions reached by Cesinaro et al1 based on a case of CD10-positive blastoid mantle cell lymphoma (MCL) with secondary cutaneous involvement that was also observed in our department.2 Aberrant surface antigen expression by MCL is not widely recognized and rarely described, but up to 30% of such cases are reported to show blastoid morphology.2 Of note, CD10 reactivity may be associated with other variant immunophenotypic [CD5 negative and Bcl-6 positive (as in the case by Cesinaro et al1)] and/or genetic (MYC rearrangement, BCL-6 translocation/amplification) features in MCL.2 Before these 2 reported cases, previous examples of blastoid MCL in the skin were CD10 negative,1,2 although a case of CD10-positive cutaneous classical MCL has been described.3
The mechanism, function, and clinical significance of aberrant surface antigen expression in MCL have been investigated but remain unclear.3 These reports highlight that an extended panel of immunohistochemical and molecular markers should be utilized in cases of diffuse cutaneous B-cell lymphoma showing unusual cellular morphology.

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