Blastoid variant Mantle Cell Lymphoma (MCL) with TP53 mutations represent an extremely high-risk disease with poor outcomes on standard chemoimmunotherapy. This case study represents the clinical challenges and therapeutic considerations in managing MCL with multiple high-risk features, including TP53 mutation, blastoid variant, CNS involvement and cutaneous dissemination. In the case study we describe clinical presentation, pathologic diagnosis, and treatment.