Part 4: Indolent B-Cell Non-Hodgkin Lymphoma
Robert Frank Cornell, MD
Hematology/Oncology Fellow, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
Timothy S. Fenske, MD
Associate Professor of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
A 70-year-old woman presents with painless cervical lymphadenopathy that has been present for several months. Her peripheral blood WBC count is 5000 cells/ÁL with an absolute neutrophil count of 2500/ÁL and absolute lymphocyte count of 1900/ÁL. Platelet count is 220,000/ÁL and hemoglobin is 13.9 g/dL. Physical exam reveals moderate bilateral cervical, axillary, and inguinal lymphadenopathy without hepatosplenomegaly. She denies any other symptoms such as fatigue, night sweats, or weight loss. Imaging by CT shows no other sites of disease. A bone marrow biopsy and aspirate demonstrates normal trilineage hematopoiesis. An excisional axillary lymph node biopsy is performed. By flow cytometry, a population of neoplastic lymphoid cells is identified which is positive for CD5, CD19, CD20 (dim), and CD23, and negative for CD10 and CD38. Cyclin D1 stain by immunohistochemistry is negative. There are no cytogenetic abnormalities identified. What is the most likely diagnosis?