Haematology: CLL versus mantle cell lymphoma: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Haematology: CLL versus mantle cell lymphoma

Sample item

A 66-year-old man has generalised painless lymphadenopathy and a lymphocyte count of 55,000 per microlitre, with smudge cells on the film. Flow cytometry shows CD19-positive, CD5-positive monoclonal B cells. Which additional finding best distinguishes chronic lymphocytic leukaemia from mantle cell lymphoma?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Expression of CD23

Both chronic lymphocytic leukaemia and mantle cell lymphoma co-express CD5 and CD19. CLL is typically CD23-positive with dim surface immunoglobulin and weak CD20, while mantle cell lymphoma is CD23-negative with cyclin D1 overexpression from t(11;14). CD10 positivity points to follicular, Burkitt or diffuse large B-cell lymphoma of germinal centre origin.

Option by option

  • A. Nuclear cyclin D1 overexpression

    Cyclin D1 overexpression is the hallmark of mantle cell lymphoma, which would argue against CLL.

  • B. Expression of CD23 (correct)

    Correct. CD23 positivity together with CD5 supports CLL, since mantle cell lymphoma is CD23-negative.

  • C. Expression of CD10

    CD10 is characteristic of germinal centre lymphomas, not of CLL or mantle cell lymphoma.

  • D. Expression of CD5

    CD5 is found in both diseases and cannot separate them.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Expression of CD23. Both chronic lymphocytic leukaemia and mantle cell lymphoma co-express CD5 and CD19.

Why is "Nuclear cyclin D1 overexpression" not the answer?

Cyclin D1 overexpression is the hallmark of mantle cell lymphoma, which would argue against CLL.

Why is "Expression of CD10" not the answer?

CD10 is characteristic of germinal centre lymphomas, not of CLL or mantle cell lymphoma.

Why is "Expression of CD5" not the answer?

CD5 is found in both diseases and cannot separate them.

What concept does this question test?

It tests Haematology: CLL versus mantle cell lymphoma in General Medicine. CLL is typically CD23-positive with dim surface immunoglobulin and weak CD20, while mantle cell lymphoma is CD23-negative with cyclin D1 overexpression from t(11;14). CD10 positivity points to follicular, Burkitt or diffuse large B-cell lymphoma of germinal centre origin.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: CLL versus mantle cell lymphoma?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.