CLL With Unusual Granulation
-
Upload
mcrantampa -
Category
Documents
-
view
219 -
download
0
Transcript of CLL With Unusual Granulation
8/3/2019 CLL With Unusual Granulation
http://slidepdf.com/reader/full/cll-with-unusual-granulation 1/1
Chronic (B cell) lymphocytic leukaemia with unusual granulation
A 79-year-old patient with chronic lymphocytic leukaemia
(CLL), in whom the neoplastic B lymphocytes from peripheral
blood (PB) and bone marrow showed intracellular granules, is
described. The diagnosis of CLL had been made in 1992(clinical stage Rai 0, Binet A). The patient remained asymp-
tomatic without any need for treatment until 5 years before
this presentation, when a significant enlargement of lymph
nodes in several areas was noted. Combination chemotherapy
(CHOP: cyclophosphamide, doxorubicin, vincristine and
prednisone) was started and subsequently replaced by a 3- to
4-weekly dose of cyclophosphamide and intermediate dose
prednisone. Clinical progression was evident over a period of
several months, with increasing lymphocytosis and lympha-
denopathy, unresponsive to chemotherapy. At this stage, an
automatic blood cell count (Advia-120; Bayer, Leverkusen,
Germany) showed a high leucocyte count (77.8 · 109/l) and
anaemia (haemoglobin, Hb: 9.9 g/dl) with a normal platelet
count. A PB film showed 96% lymphocytes with 90% of these
containing variably sized, round, azurophilic cytoplasmic
granules (left). Some cells also showed small vacuoles.
Neoplastic lymphocytes did not show acid hydrolases on
cytochemical staining. Immunophenotyping showed that 95%
of lymphocytes expressed a characteristic CLL phenotype: B
lineage (CD19) with co-expression of CD23 and CD5 and
weak expression of CD20, CD22 and CD79b. The neoplastic
population showed co-expression of immunoglobulin (Ig)D
and IgM, a restricted lambda light chain pattern and high
expression of CD38 (>30%) and ZAP-70 (>20%). Cytogeneticanalysis showed t(1;4)(q31;q33) and trisomy 12. Transmission
electron microscopy (TEM) showed that PB lymphocytes
contained variably sized, irregular, dense, cytoplasmic granules
(right, TEM · 10 000). The incidence of cytoplasmic inclu-
sions in CLL lymphocytes is very low: membrane-bound
vacuoles and crystal-like or filamentous inclusions have
occasionally been reported. An immunoglobulin origin of the
very unusual cytoplasmic granules in this patient is highly
probable.
Anna Merino1
Marıa Rozman2
Jordi Esteve3
1Department of Haemotherapy-Haemostasis, Hospital Clınic, Centro de
Diagnostico Biomedico (CDB), Barcelona, 2Haemopathology Unit,
Hospital Clınic, CDB, Barcelona, and 3Hospital Clınic, Haematology
Department, Barcelona, Spain
E-mail: [email protected]
images in haematology
doi:10.1111/j.1365-2141.2006.06039.x ª 2005 Blackwell Publishing Ltd, British Journal of Haematology , 133, 354