Case 9- Discussion

Uploaded: 2007-06-09, Updated: 2007-06-19

B-CELL PROLYMPHOCYTIC LEUKEMIA (B-PLL)

Clinical Futures

• B-PLL de novo: prolymphocytes > 55%of all lymphoid cells in peripheral blood, more aggressive than B-CLL;

• B-CLL/PLL: mixed B-CLL and PLL (<55%);

• B-CLL progression: PLL >55% with a history of CLL. Only 50% cases have an identical gene arrangement, and therefore 50% cases represent a second leukemic clone; worse prognosis;

• Most de novo B-PLL have splenomegaly, but in contrast to B-CLL, no adenopathy.

Microscopic Findings

• Medium to large cells with a moderate amount of cytoplasm;

• Condensed chromatin (more open than CLL) with prominent central nucleoli.

Subtypes

Differential Diagnosis

Immunohistochemistry Straining

• PLL arising from CLL: CD5+; de novo PLL: CD5-;

• CD20 and sIg: moderate, not as dim as in B-CLL;

• Many cases CD23-;

Cytogenetics

Treatment and Prognosis

Reference

• Flow cytometry in neoplastic hematology. Wojciech Gorczyca. 2006