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Chapter 105. Malignancies of Lymphoid Cells (Part 13)

Chronic lymphocytic leukemia. The peripheral white blood cell count is high due to increased numbers of small, well-differentiated, normal-appearing lymphocytes. The leukemia lymphocytes are fragile, and substantial numbers of broken, smudged cells are usually also present on the blood smear. If the primary presentation is lymphadenopathy and a lymph node biopsy is performed, pathologists usually have little difficulty in making the diagnosis of small lymphocytic lymphoma based on morphologic findings and immunophenotype. However, even in these patients, 70–75% will be found to have bone marrow involvement and circulating monoclonal B lymphocytes are often present. . | Chapter 105. Malignancies of Lymphoid Cells Part 13 Figure 105-6 Saurea Fivti as DL. BraunvaM f 51. Longo DL. JI. Lotc.lro J j T . i-a.rJ.r nt.rnaj Ai.-j oiT . 1.7th Edition I http wv i. ocesim. d-cin . cpm Co plight r . Th nc. All HflKt Chronic lymphocytic leukemia. The peripheral white blood cell count is high due to increased numbers of small well-differentiated normal-appearing lymphocytes. The leukemia lymphocytes are fragile and substantial numbers of broken smudged cells are usually also present on the blood smear. If the primary presentation is lymphadenopathy and a lymph node biopsy is performed pathologists usually have little difficulty in making the diagnosis of small lymphocytic lymphoma based on morphologic findings and immunophenotype. However even in these patients 70-75 will be found to have bone marrow involvement and circulating monoclonal B lymphocytes are often present. The differential diagnosis of typical B cell CLL is extensive Table 105-1 . Immunophenotyping will eliminate the T cell disorders and can often help sort out other B cell malignancies. For example only mantle cell lymphoma and typical B cell CLL are usually CD5 positive. Typical B cell small lymphocytic lymphoma can be confused with other B cell disorders including lymphoplasmacytic lymphoma i.e. the tissue manifestation of Waldenstrom s macroglobulinemia nodal marginal zone B cell lymphoma and mantle cell lymphoma. In addition some small lymphocytic lymphomas have areas of large cells that can lead to confusion with diffuse large B cell lymphoma. An expert hematopathologist is vital for making this distinction. Typical B cell CLL is often found incidentally when a complete blood count is done for another reason. However complaints that might lead to the diagnosis include fatigue frequent infections and new lymphadenopathy. The diagnosis of typical B cell CLL should be considered in a patient presenting with an autoimmune hemolytic anemia or autoimmune thrombocytopenia. B cell .