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Test and teach number one hundred and one: part 1
Pathology (2000 ) 32, pp. 118
TEST AND TEACH Number One Hundred and One: Part 1 DAV ID A. WESTERM AN
AND
SURENDER K. JUNEJA
Department of Pathology, Peter MacCallum Cancer Institute, Melbourne, Australia
CASE REPORT A 75-year-old retired foundry worker with a past history of carcinoma of the bladder treated with local radiotherapy 12 months before presentation, was referred for investigation of a modest lymphocytosis , found incidentally on full blood examination (FBE). On examination multiple small 1 cm cervical, axillary and inguinal nodes, and 11 cm splenomegaly were noted. FBE parameters included: hemoglobin (Hb) 128 g/l, MCV 99 fl (NR 80– 96 fl), WCC 28.9´ 10 9 /l, lymphocyte s 17.3 ´10 9 /l, platelets 136´ 10 9 /l (Fig. 1). Serum LDH was 634 U/l (230– 460), b 2 -microglobulin 3.5 mg/l (NR 0.8–3.0 mg/l) and no paraprotein was detected on protein electrophoresis. Bone marrow aspirate and trephine (Fig. 2) showed an interstitial lymphoid infiltrate. Immunophenotyping demonstrated a population of lymphoid cells
Fig. 1 Peripheral blood showing typical hairy cell leukaemia variant cell (Romanowsky stain, original magnification ´400).
expressing CD 5– , 19 + , 20 + , 22 + , 11c + , 103 + , 25– with k light chain restriction. The patient was managed expectantly and re-presented 6 months later with severe lethargy. FBE indices were Hb 64 g/l, WCC 35.7´ 10 9 /l, platelets 223´ 10 9 /l. Repeat bone marrow aspirate revealed < 1% erythroblasts on differential. Parvovirus serology, liver function tests and chest X-ray were normal. Twelve months later the patient underwent splenectomy (Fig. 3) after failing to respond to therapy with 2-chlorodeoxyadenosine. Accepted 16 December 1999 See pages 137– 138 for explanation and diagnosis.
Fig. 3 Splenic section showing a diffuse red pulp leukaemic infiltrate (H&E, original magnification, ´ 400).
Fig. 2 Bone Marrow Trephine Biopsy showing interstitial leukaemic infiltrate (H&E, original magnification ´ 400).
ISSN 0031–3025 printed/ISSN 1465– 3931 online/00/020118 –01 © 2000 Royal College of Pathologists of Australasia
TEST AND TEACH Number One Hundred and One: Part 1 DAV ID A. WESTERM AN
AND
SURENDER K. JUNEJA
Department of Pathology, Peter MacCallum Cancer Institute, Melbourne, Australia
CASE REPORT A 75-year-old retired foundry worker with a past history of carcinoma of the bladder treated with local radiotherapy 12 months before presentation, was referred for investigation of a modest lymphocytosis , found incidentally on full blood examination (FBE). On examination multiple small 1 cm cervical, axillary and inguinal nodes, and 11 cm splenomegaly were noted. FBE parameters included: hemoglobin (Hb) 128 g/l, MCV 99 fl (NR 80– 96 fl), WCC 28.9´ 10 9 /l, lymphocyte s 17.3 ´10 9 /l, platelets 136´ 10 9 /l (Fig. 1). Serum LDH was 634 U/l (230– 460), b 2 -microglobulin 3.5 mg/l (NR 0.8–3.0 mg/l) and no paraprotein was detected on protein electrophoresis. Bone marrow aspirate and trephine (Fig. 2) showed an interstitial lymphoid infiltrate. Immunophenotyping demonstrated a population of lymphoid cells
Fig. 1 Peripheral blood showing typical hairy cell leukaemia variant cell (Romanowsky stain, original magnification ´400).
expressing CD 5– , 19 + , 20 + , 22 + , 11c + , 103 + , 25– with k light chain restriction. The patient was managed expectantly and re-presented 6 months later with severe lethargy. FBE indices were Hb 64 g/l, WCC 35.7´ 10 9 /l, platelets 223´ 10 9 /l. Repeat bone marrow aspirate revealed < 1% erythroblasts on differential. Parvovirus serology, liver function tests and chest X-ray were normal. Twelve months later the patient underwent splenectomy (Fig. 3) after failing to respond to therapy with 2-chlorodeoxyadenosine. Accepted 16 December 1999 See pages 137– 138 for explanation and diagnosis.
Fig. 3 Splenic section showing a diffuse red pulp leukaemic infiltrate (H&E, original magnification, ´ 400).
Fig. 2 Bone Marrow Trephine Biopsy showing interstitial leukaemic infiltrate (H&E, original magnification ´ 400).
ISSN 0031–3025 printed/ISSN 1465– 3931 online/00/020118 –01 © 2000 Royal College of Pathologists of Australasia