A 48 year old woman was admitted with a history of weakness for two months. On examination, she has enlarged cervical lymph nodes and spleen. Her hemoglobin was 10.5 g/dl, platelet count 2.7 x 109/L and total leukocyte count 40 x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient, will most likely exhibit effacement of lymph node arachitecture by:
Patient in the question stem is showing features of chronic lymphocytic leukemia. Histopathological examination in a case of CLL shows diffuse effacement of lymphocyte architecture by small to medium sized lymphocytes with clumped chromatin, indistinct or absent nucleoli and scanty cytoplasm. Chronic lymphocytic leukemia (CLL) is a clonal malignancy of B lymphocytes. It is manifested clinically by immunosuppression, bone marrow failure, and organ infiltration with lymphocytes. Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 13
A pseudofollicular pattern with proliferation centers
A monomorphic lymphoid proliferation with a nodular pattern
A predominantly follicular pattern
A diffuse proliferation of medium to large lymphoid cells with high mitotic rate