What is the Mantle?

Among the many fairly commonly mentioned subtypes of non-Hodgkin's lymphoma--but one that is rather rare within them--is mantle cell lymphoma (MCL).

Doctors and researchers are still learning about this particular subtype. As recently as a few years ago, MCL was considered an indolent or slow-growing cancer that presented little immediate threat to the individual.

However, that view has changed and it is now believed that the large majority of patients with mantle cell lymphoma in fact have an aggressive disease that requires aggressive treatment.

As many as four in five patients with mantle cell lymphoma likely have an aggressive disease and will require front-line treatment involving combination chemotherapy followed by a stem cell transplantation. The remaining 20 percent of MCL patients will have an indolent disease.

One issue that tends to elude many people is the name: mantle cell lymphoma. In other words, what is the 'mantle' in mantle cell lymphoma?

The Mantle

The anatomy of a lymph node is rather complex, and is divided into seven major regions.

Among these seven regions is one called the lymph node cortex. Within the lymph node cortex is a primary lymphoid follicle and a secondary lymphoid follicle.

If one's immune system is not being stimulated by some foreign pathogen, then there is only a primary lymphoid follicle, which contains B-lymphocytes which are either 'virgin' (uncirculated) or 'memory' (circulated). When the immune system is stimulated by a foreign pathogen, the B-lymphocytes that recognize the pathogen begin to replicate and develop.

This process converts the primary lymphoid follicle into a secondary lymphoid follicle (or 'germinal center') which is then surrounded by a band of small lymphocytes—or a mantle zone.

When B-lymphocytes from this 'zone' become cancerous, the subtype is identified as mantle zone lymphoma. Determining that this is indeed the source of the cancerous lymphocytes is not easy, and requires a number of laboratory techniques to reach such a diagnosis.

Thus, in short, the mantle zone is an area full of B-lymphocytes within a region of the lymph node. Mantle zone lymphoma is a cancer that arises from the cells in this region.

Picture of lymph node with mantle cell lymphoma by Gabriel Caponetti