08/02/2010
Anemia.
California Hospital Medical Center
65-year-old female anemia unresponsive to therapy. History of leukemia.
Procedure: Bone marrow biopsy and aspirate and peripheral blood smears.
Micro: The marrow is filled with sheets of cytoplasmic lymphocytes with fairly well defined borders and small round to irregular darkly stained nuclei. A "fried egg" appearance of tumor cells is evident on high power views. Only occasional small foci of hematpoietic marrow are identified. H & E stain
IHC stains: limited panel including CD20.
Diagnosis:
Hairy cell leukemia, recurrent.
DDx:
Flow cytometry: An abnormal lymphoid population is identified as CD19++, CD20++(bright),CD10-,CD5-,CD38-,CD11c+,CD25+,CD103+ and with lambda light chain restriction.
Discussion:
Enormous progress has been made in the management of patients with hairy cell leukemia (HCL) over the past 50 years since this disease was initially described in 1958. The introduction of the two commonly used purine nucleoside analogs (pentostatin and cladribine, respectively) has independently changed the natural history of this rare malignancy. Both agents are equivalent in terms of response and long-term results. Advances in therapy are being further pursued with inclusion of monoclonal antibodies (e.g. rituximab) and other immunotherapeutic approaches. Patients with this disease now can live a near normal life expectancy, but the disease has not yet been cured. Clinical trials must continue to address the remaining unanswered questions.
References:
Grever MR, Zinzani PL. Long-term follow-up studies in hairy cell leukemia. Leuk Lymphoma. 2009 Oct;50 Suppl 1:23-6.
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Comments
Good case of hairy cell leukemia
hairy cell leukemia
very nice case
Hairy cell leukemia.
Very Nice ImagesI
very good images
Great slide, I will borrow this as well! Thanks.
Nice images