How to differentiate between CLL and Mantle cell lymphoma

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  • Mantle cell lymphoma may be difficult to differentiate clinically at the time of presentation from chronic lymphocytic leukemia/small lymphocytic lymphoma, marginal zone lymphoma, or lymphoplasmacytic lymphoma. 
  • Mantle cell lymphoma is best diagnosed by either demonstration of cyclin D1 overexpression by immunohistochemistry or presence of the t(11;14) translocation by FISH. This translocation juxtaposes the immunoglobulin heavy chain region on chromosome 14 with the cyclin D1 gene (BCL1) on chromosome 11. 
  • Flow cytometry is also very helpful if the typical mantle cell lymphoma immunophenotype is expressed, namely, strong expression of monoclonal immunoglobulin on the cell surface as well as strong expression of CD5, CD19, CD20, and CD22, with absence of expression of CD10 and CD23. 
  • The immunophenotype typical of chronic lymphocytic leukemia, will have low levels of surface immunoglobulin and CD20 expression in association with expression of both CD5 and CD23.

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