Case 7- Discussion

Uploaded: 2007-06-07, Updated: 2007-06-19


MICROSCOPIC EXAM:
 

PERIPHERAL BLOOD        

Severe neutropenia and lymphocytopenia are present. Occasional circulating hairy lymphoid cells are seen. The hairy cells are small to medium with slightly indented nucleus and nucleolus, the the hairy cells have small to moderate amount of basophilic cytoplasm with cytoplasmic hairy projections. Mild normocytic normochromic anemia, mild anisopoikilocytosis and polychromasia are noted. Few tear-drop cells are seen. Thrombocytopenia is present with most platelet showing unremarkable morphology.

     

BONE MARROW CORE BIOPSY AND CLOT SECTION:

The overall cellularity is 40%. Trilineage hematopoiesis is present. M:E ratio is 1:1. The myeloid series is decreased. The erythroid series is increased. Megakaryocytes are adequate in number with unremarkable morphology. Focal nodular B-lymphocyte infiltrates are noted that are composed of small to medium size lymphocytes with clear cytoplasm, and the infiltrative cells are positive for CD20 and CD79a and occupy about 10% of the overall cellularity. Few scattered CD3+ T-cells comprising <5% seen.

     

BONE MARROW ASPIRATE SMEAR AND TOUCH IMPRINTS:

The myeloid series is decreased with unremarkable maturation. Scattered small lymphocytes and large granular lymphocytes are noted. Scattered hairy lymphoid cells are seen. Occasional plasma cells are noted. The erythroid series is increased in number with progressive maturation. The megakaryocytes are adequate in number with unremarkable morphology. Iron stain reveals normal iron stores. No ringed sideroblasts are seen. 

     

DIFFERENTIAL:

A count of 300 non-erythroid nucleated cells yields a following differential:

       Blasts: 1%, Promyelocytes: 3%, Myelocytes: 7%, 

       Metamyelocytes: 19%, Bands: 25%, Neutrophils: 27%, 

       Eosinophils: 3%, Lymphocytes: 11%, Plasma cells: 1%,

       Monocytes: 3%. 

FLOW CYTOMETRY INTERPRETATION
 

Bone marrow: A small monoclonal B-cell population is detected that consists of 1.1% of marrow cells, and these cells express CD19, CD25, CD11c, CD103 with kappa light chain restriction This phenotype is consistent with hairy cell leukemia. 

     

      Total events             A gate Bright CD45+

      analyzed=65285           events=10669 (23% of

                               total nucleated cells)

        CD45+                          100%

        CD5+/CD19+                      <2%

        CD5+/CD19-                      45%

        CD19+/CD11c+                     6%

        CD19+/CD25+                      5%

        CD19+/CD103+                     5%

 

                Gated on CD19+ cells

        CD19+/sIg Kappa+                96%

        CD19+/sIg Lambda+                3%

 

CYTOGENETICS (UNMC, Cytogenetics)

 

Normal male chromosome complement.  There was no cytogenetic evidence of an abnormal clone in this bone marrow specimen at this band level. 

IMMUNOHISTOCHEMISTRY STAINS

 

CD20

DIAGNOSIS

 

HAIRY CELL LEUKEMIA

 
Clinical Futures
   
Microscopic Findings
 
  • Medium-sized with pale cytoplasm;
  • Oval, reniform or bean-shaped nuclei and clumped or evenly dispersed chromatin;
Subtypes
   
Differential Diagnosis
   
Immunohistochemistry Staining
 
CD5 CD10 CD11c CD20 CD25 CD45 CD79a CD103 BCL1 BCL2 BCL6 κ/λ PAX5
+bright +bright + + + + −/+ + +bright +/−
Cytogenetics
   
Treatment and Prognosis
   
Reference
 
  • Flow cytometry in neoplastic hematology. Wojciech Gorczyca. 2006