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Case 9 - Discussion

Hematopathology Case


  • The prolymphocytes in B-PLL may resemble myeloblasts. However, compared with myeloblasts, they usually have slightly less delicate chromatin, and more and pale blue cytoplasm with no granules.

  • They can also mimic circulating blastoid mantle cell lymphoma cells, but the blastoid MCL cells typically have higher N/C ratio and small or inconspicuous nucleoli.


B-Cell Prolymphocytic Leukemia (B-PLL)

    De novo, prolymphocytes > 55%

   Marked leukocytosis, often >100 109/L

   Splenomegaly, no or minimal lymphadenopathy


o  Cell size: medium, minimal cell-to-cell variability

o  Nucleus: round, no significant irregularity, moderately condensed chromatin, single prominent nucleolus

o  Cytoplasm: moderate, well-defined borders

   BM : typically extensively diffuse or interstitial involvement, uniform tumor cells, small to medium size, prominent small central nucleolus, and a rim of amphophilic cytoplasm

   Spleen: involvement of both red and white pulp regions, with expansion of red pulp sinusoids and white pulp


o  Positive: CD19, CD20, CD22, CD79a, FMC7

o  CD5+, <50%

o  CD23 negative

   17p-, 50%, deletion of TP53; lack of t(11;14)(q13;q32)

   Rapid clinical course with poor outcome