An
interesting case; A 63-year-old woman being followed for splenomegaly
presented with lymphocytosis
·
haemoglobin, 14 g/dL
·
neutrophils, 2.5 × 10^9/L
·
lymphocytes, 8.5 × 10^9/L
·
monocytes, 0.7 × 10^9/L
·
platelets, 200 × 10^9/L.
A
blood smear showed 40% medium-sized lymphocytes with abundant cytoplasm with
circumferential projections, similar to those of classic hairy cells. The
nucleus had condensed chromatin with a conspicuous nucleolus (see the piccie
above).
Now
here’s the rub - flow cytometry showed 45% clonal B lymphocytes that expressed CD19
/ CD20 / CD22 / CD103 / CD11c and a lack of CD5 / CD10 / CD123 / CD25 / CD200.
The BRAFV600E mutation was negative, confirming the diagnosis of hairy cell
leukemia-variant (HCL-v).
The
article actually says “Despite
morphologic similarities, HCL-v is not biologically related to classic HCL
(cHCL).” How things have changed. Morphology is not the be-all and end-all
which once it was. Immunophenotyping is clearly the way forward. How long will
it be before this is a technique available in all district general hospitals?
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