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Case 42

Hematopathology Case

CLINICAL INFORMATION

 

A 58-year-old male was diagnosed as chronic lymphocytic leukemia in 2000. He was stable until 2006 when he was found to have extensive systemic lymphadenopathy and splenomegaly with an peripheral lymphocyte count of approximately 90K. Multiple clinical and pathological workups showed involvement of CLL/SLL in the lymph nodes (Hematopathology case 36), ureter, bone marrow and CSF. The neoplastic lymphocytes were positive for CD5, CD19, CD20 and CD23 with kappa light chain restriction, but had no expression of CD38 or ZAP70. He received five cycles of chemotherapy with maintenance of rituximab every two months since then. In January 2008, image studies demonstrated extensive systemic lymphadenopathy up to 12 cm, moderate splenomegaly, right apical nodules of the lung, and multiple lytic lesions of the vertebral bodies. He also complained of dysphagia and EGD showed an ulcerated mass (2.5 2.0 cm) at the GE junction and multiple nodules (0.1 to 0.3 cm) in the body of stomach, and a biopsy of the mass at GE junction was performed (Hematopathology case 41). A bone marrow biopsy was also performed at the same time.

 

 

BONE MARROW ASPIRATE AND SMEAR

 

 

Bone marrow smear. Wright-Giemsa. 100

Bone marrow smear. Wright-Giemsa. 100

 

 

Bone marrow smear. Wright-Giemsa. 100

Bone marrow smear. Wright-Giemsa. 100

 

 

Bone marrow, cytospin. Wright-Giemsa. 100

Bone marrow, cytospin. Wright-Giemsa. 100

 

 

 

Bone marrow, cytospin. Wright-Giemsa. 100

 

 

BONE MARROW CORE BIOPSY AND CLOT

 

 

 

HE, 4

HE, 20

 

 

HE, 20

HE, 40

 

 

HE, 40

HE, 40

 

FLOW CYTOMETRY

 

 

 

 

CD45 vs. side scatter

H-gate, CD38 vs.. CD45

 

 

H-gate, CD19 vs. CD38

 

H-gate, CD20 vs. CD38

 

 

 

 

H-gate, CD8 vs. CD4

 

 

 

Click here for diagnosis and case discussion

 

Source: Department of Pathology, Creighton University Medical Center, Omaha, NE