A very strange case of HCL!

Wed Sep 6 12:18:11 EST 2000

Greetings All, I normally don't try to bother you folks with unusual cases but we have
had one that I would like to share and inquire about as it has us very puzzled. We
recently had a patient with a diagnosis of Hairy Cell Leukemia. His phenotype was
classic HCL with the exception of CD23 positivity. The cells were strongly positive
for lambda surface light chains. However, he demonstrated  monoclonal kappa IgM
by immunoelectrophoresis. We were  concerned that an error may have occured in the
immunophenotyping and requested a  new specimen. Repeat analysis again demonstrated
monoclonal lambda surface light chains. We then proceeded to measure cytoplasmic light
chains and found the cells in question to have a cytoplasmic kappa pool as well  lambda.

 I have two questions:

1. Has anyone ever seen this before?

2. Is it theoretically possible for leukemic cells to express one type of light chain
on the surface and be  synthesizing and secreting the other?

Thanks, Tom

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