A 48 year old woman 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 237 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, CD 5,CD 20 and Cd 23 and were negative for CD 79 B and FMC - 7.What is the most likely diagnosis ?
Ans. is 'b' i.e., Chronic lymphocytic leukemiaThe clinical presentation and the immunophenotype pattern suggests the diagnosis of mantle cell lymphoma on first instance, but it is definitely a case of chronic lymphocytic leukemia (CLL)The immuno phenotypic finding that confirms the diagnosis of CLL is CD 23 positive CD 23 is used to distinguish between mantle cell lymphoma and CLL Mantle cell lymphoma - CD 23 (-ve)Chronic lymphocytic leukemia - CD 23 (+ve)Both mantle cell lymphoma and CLL are B cell neoplasm and both will express pan B cell markers such asCD 19CD 20CD 22The unique feature of immuno phenotypic pattern of both these cases is that despite being B cell neoplasms they are paradoxically positive for CD 5 Which is a marker for T cells CLL cells are typically absent for - CD 79 B and FM 7 More about CLLThe diagnosis of typical B cell ell is made whenIncreased number of lymphocytes i.e. > 4 X 109/ L and usually greater than 10 X 109/ LLymphocytes are monoclonal B cells and display CD5Finding bone marrow infiltration by same cellsPeripheral blood cell show smudge or basket cells Some markers are more specific than others.Presence of these markers confirm the presence of cells of those lineage These specific markers are* B lymphocyte-79a* T lymphocyte-Cytoplasmic CD3* Myeloid series-Anti MPO* Monocyte-CD 14, Anti lysozymeOther markers which you shouldknow* Langerhans' cell-CD 1a and S100histiocytes* Precursor lymphoma-TdT(pre B and pre T)* Plasma cells-CD 38* Precursor and follicular - CD 10 (CALLA)B cells
T - cell rich B - cell lymphoma with leukemic spill over in blood.
Chronic lymphocytic leukemia
mantle cell lymphoma
A definite diagnosis can not be made in this patient without lymph node biopsy.
Blood