A 48 year old women was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7x109/L and total leukocyte count 40x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD 5, 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 architecture by
Answer is A (A pseudofollicular pattern with proliferation centres) Coexpression of CD19 and CD 5 together with negative CD 79 and FMC7 markers suggest a diagnosis of chronic lymphocytic leukemia (CLL) The histapathological examination of lymph nodes in CLL shows characteristic effacement of normal nodal architecture by diffuse proliferation and infiltration of small round lymphocytes (and not medium to large Iyumphocytes). Pseudofollicular growth centres or proliferation centres are present in most cases and when present proliferation centres are considered pathognomic of CLL/SLL Approach to the question What is the diagnosis of the patient in question? The patient in question is case of CLL CLL is characterized by coexpression of CD5 and CD190 CLL is characteristically positive for CD23 and usually negative for CD7/9b and FMC7Q Lymphoma CD5 CD19 CD20 CD23 CD79b FMC7 CLL + + +1- + - - What are the histopathological characteristics of CLL? Histopathological Features of CLL (Robbins/Williams/Haffman) Lymph nodes in patients with CLL characteristically are diffusely infiltrated with monomorphic small round lymphocytes that efface the normal node architecture Diffuse effacement by a predominant population of small lymphocytes These cells may be mixed with variable number of larger cells called prolymphocytes, but the predominant cells remain small lymphocytes. The predominant cell is a small lymphocyte with clumped nuclear chromatin. Pseudofollicular growth centres or proliferation centres are present in most cases. When present proliferation centres are considered pathognomic of CLL/SLL Proliferation centres are clusters of prolymphocyte appearing cells that form aggregates or pseudofollicles, and so called because they contain a large number of mitotically active cells.
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.