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Hyperplasia of Mantle/Marginal Zone B Cells With Clear Cytoplasm in Peripheral Lymph Nodes
A Clinicopathologic Study of 35 Cases

John P. Hunt MD, Joel A. Chan MD, Michael Samoszuk MD, Russell K. Brynes MD, Antonio M. Hernandez MD, Randall Bass MD, Dennis D. Weisenburger MD, Konrad Müller-Hermelink MD, Bharat N. Nathwani MD
DOI: http://dx.doi.org/10.1309/P2M2-JEA3-YYQF-0P38 550-559 First published online: 1 October 2001


We describe 35 peripheral lymph nodes classified as mantle cell/marginal zone B-cell hyperplasia with clear cells using morphologic and immunologic findings. For the purpose of this study, we obtained clinical follow-up information and performed immunoglobulin gene rearrangement studies on paraffin sections by polymerase chain reaction. Architecturally, the nodes were suggestive of a benign process: no pericapsular infiltration, sinuses readily identified, scattered reactive follicles present, and paracortical nodular hyperplasia present. No monocytoid B cells were present. Focally, small lymphoid cells with round nuclei and clear cytoplasm (clear cells) formed monomorphic nodular, inverse follicular, and/or marginal zone patterns. Flow cytometry and immunohistochemical analysis revealed neither light chain restriction nor an aberrant B-cell phenotype. Immunoglobulin gene rearrangement studies showed a clonal band in 1 of 26 cases in which DNA was amplified. To ascertain the clinical relevance of this positive case, follow-up information was obtained 30 months after the initial biopsy; the 83-year-old woman was alive without treatment but had splenomegaly and bone marrow involvement by marginal zone B-cell lymphoma. The morphologic and immunologic criteria used for diagnosis of mantle cell/marginal zone B-cell hyperplasia with clear cytoplasm are valid; however, to rule out the possibility of occult lymphoma, immunoglobulin gene rearrangement studies and clinical follow-up are necessary.

Key Words:
  • Mantle cells with clear cytoplasm
  • Marginal zone B cells
  • Primary follicles
  • Mantle cell hyperplasia
  • Marginal zone B-cell hyperplasia
  • Non-Hodgkin lymphoma