Case History

Case number: 00008

A 60 year-old male is referred to you for a neck mass. He has some numbness around his jaw. There is no history of weight loss, night sweats or fever. An MRI scan showed a sub-mandibular mass extending into the mandible.

Biopsy of the neck mass showed a diffuse small lymphoid infiltrate. On immunohistochemistry, the cells were CD79A+, PAX5+, CD5+, CD10- and CD23+.

Answer the following questions before proceeding.

  1. What are your top two differentials?
  2. Which stain would you request to distinguish between them?

Further analysis shows that the atypical cells are cyclin D1 negative. LEF1 is positive. Ki67 is 20%.

A full blood count reveals a lymphocytosis (absolute count 15×10^9). The haemoglobin and platelet count are normal. Flow cytometric analysis shows that the lymphoid cells are CD45 positive, SSC-low, CD 19+, CD 20 dim, CD 5+, CD23+, CD200+, CD38-, kappa-restricted and sIgM dim.


  1. What are the components of the Marsden score?
  2. What is the diagnosis?
  3. What are the indications for treatment of an indolent lymphoma?
  4. Before starting treatment, what is the most important investigation to perform?