Mature lymphoproliferative disorders

19 Mature lymphoproliferative disorders


Mature lymphoproliferative disorders frequently are derived from a single clone of cells. Although this group of diseases involves lymphocytes, the morphological presentation is variable. The integration of clinical and morphological disease features with immunophenotyping is necessary for appropriate recognition and classification. Only representative samples are included in this atlas.


NOTE: Sustained absolute lymphocytosis in an adult should be investigated to differentiate reactive from malignant processes. Characteristics of reactive lymphocytes are listed in Table 14-1.



Chronic lymphocytic leukemia



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FIGURE 19–1A Small lymphocytes with smudge cells at arrows (PB ×500).


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FIGURE 19–1B Albumin smear-same patient as presented in figure 19-1A (PB ×500).


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FIGURE 19–1C Small lymphocytes with smudge cell (PB ×1000).


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FIGURE 19–1D (BM ×500).




Morphology



Peripheral blood:


Mature-appearing lymphocytes with round nuclei and block-type chromatin; inconspicuous nucleoli, scant cytoplasm; homogeneous appearance within a given patient; lymphocytes more fragile than normal, leading to “smudge” cells



Absolute sustained lymphocytosis


± Normocytic normochromic anemia (approximately 10% of patients develop an autoimmune hemolytic anemia)


± Thrombocytopenia



Bone marrow:


≥30% lymphocytes



Immunophenotype


CD20+, CD19+, CD5+, CD23+





Note:

Addition of albumin to blood prior to smear preparation stabilizes CLL cells, decreasing the formation of smudge cells and allows for accurate cell classification.



B cell prolymphocytic leukemia



Morphology



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FIGURE 19–2A (PB ×500).


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FIGURE 19–2B (PB ×1000).


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FIGURE 19–2C (BM ×500).


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FIGURE 19–2D (BM ×1000).



Peripheral blood:


Medium-sized cells (approximately twice the size of small lymphocyte), one prominent nucleolus, moderately condensed chromatin; small-to-moderate slightly basophilic cytoplasm



Absolute lymphocytosis, usually >100 × 109/L


Anemia

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Hematopoiesis Precursor lymphoid neoplasms Variations in size and color of erythrocytes Microorganisms Variations in shape and distribution of erythrocytes Diseases affecting erythrocytes

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Jun 12, 2016 | Posted by in HEMATOLOGY | Comments Off on Mature lymphoproliferative disorders

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