interesting clinical case

Brent Dorsett brentd at
Thu Sep 21 09:44:46 EST 2000

A PB was sent to our lab for lymphoma/leukemia immunophenotyping. The
patient is a 70 year old man with a history of CLL. His total white count
was 16,000 with a lymphocyte count of  11%. Here is what we found on flow:
CD45 bright, CD20 bright ( 70% ), Lambda bright ( 60% ), Kappa 0%, CD19+,
CD22 Dim+ ( 65% ), CD23 Dim+ ( 55% ), FMC7 dim+, CD11c-, CD10-, CD43- ( on
B-cells ), CD5- ( on B-cells ). So in summary, the patient has no
coexpression of CD5 and CD19 as well as CD5 and CD20, has bright CD20 and
Lambda restriction, is CD23+ , CD10-. My question is: does this patient have
a variant of CLL, a CLL/PLL transformation, or a lymphocytoid leukemia? The
CD5 negativity and bright CD20 is not the standard pattern of CLL, and the
lack of FMC7 bright positivity doesn't go with PLL. Any insights from the
experts? Morphologically, the cells could be prolymphocytes but the
pathologist is not sure.



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