View Case

450a)
A 63-year-old woman with hypertension and hyperlipidemia presents to her primary care physician for a routine checkup. She feels well and has well-controlled blood pressure and lipid levels; however, a complete blood cell count shows mild leukocytosis (white blood cell [WBC] count, 13.0 × 10⁹/L; reference range, 3.54 to 9.06 × 10⁹/L) with atypical lymphocytosis (60% neutrophils, 5% lymphocytes, 30% atypical lymphocytes, 3% monocytes, and 2% eosinophils; reference ranges, 40% to 70% neutrophils, 20% to 50% lymphocytes, 2% to 8% monocytes, 0% to 6% eosinophils, 1% to 2% basophils). Her physician chooses to send a sample for flow cytometry evaluation. Representative flow cytometry results are shown in Figures 1, 2, and 3. Use this scenario to answer the following four questions.

Which one of the following is the most appropriate diagnosis for this patient?

B-cell prolymphocytic leukemia (B-PLL). Chronic lymphocytic leukemia (CLL). Hairy cell leukemia (HCL). Monoclonal B-cell lymphocytosis (MBL). Reactive lymphocytosis (RL).

450b) The patient receives appropriate therapy and follow-up for her diagnosis but returns over the following year with increasing leukocytosis (white blood cell [WBC] count ≥52 × 10⁹/L for 4 months; reference range, 3.54 to 9.06 × 10⁹/L) and increasing atypical lymphocytosis (11% neutrophils, 12% lymphocytes, 74% atypical lymphocytes, 2% monocytes, and 1% eosinophils; reference ranges, 40% to 70% neutrophils, 20% to 50% lymphocytes, 2% to 8% monocytes, 0% to 6% eosinophils, 1% to 2% basophils). Flow cytometry shows the same immunoprofile noted previously. A peripheral blood smear at this time is shown in Figure 4. Which one of the following is the most appropriate diagnosis for this patient at this time?

B-cell prolymphocytic leukemia (B-PLL). Chronic lymphocytic leukemia (CLL). Hairy cell leukemia (HCL). Large granular lymphocytic leukemia (LGL leukemia). Monoclonal B-cell lymphocytosis (MBL).

450c) Which one of the following factors is associated with the best prognosis in this disease?

CD38 expression. Deletion 13q. Deletion 17p. Germline immunoglobulin heavy variable cluster (IGHV) gene. ZAP-70 (ζ-chain [T-cell receptor]-associated kinase 70) expression.

450d) Several years later, this patient’s disease progresses again and she is noted to have several enlarged lymph nodes. Eight months after this development, the patient dies. Which one of the following is the most likely diagnosis for this patient’s transformed disease?

Acute lymphoblastic leukemia (ALL). Classic Hodgkin lymphoma (CHL). Diffuse large B-cell lymphoma (DLBCL). Large granular lymphocytic leukemia (LGL leukemia). Small lymphocytic lymphoma (SLL).

Clinical Pathology: General Principles, Hematology & Coagulation, Immunology & Histocompatibility, Urinalysis, Body Fluids, Clinical Microscopy, Genetic Testing

450c) Which one of the following factors is associated with the best prognosis in this disease?

450d) Several years later, this patient’s disease progresses again and she is noted to have several enlarged lymph nodes. Eight months after this development, the patient dies. Which one of the following is the most likely diagnosis for this patient’s transformed disease?

View Notes

Add a Note