B cell small lymphocytic lymphoma/chronic lymphocytic leukemia

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B cell small lymphocytic lymphoma/chronic lymphocytic leukemia, often referred to as chronic lymphocytic leukemia (abbreviated CLL) or small lymphocytic lymphoma (abbreviated SLL), is a common low-grade hematologic malignancy. It typically afflicts older individuals.

B cell small lymphocytic lymphoma/chronic lymphocytic leukemia
Diagnosis in short

Small lymphocytic lymphoma. H&E stain.
LM mixed population of lymphoid cells with "proliferation centers": (1) nodular collections of larger cells (~ 1.5x the size of resting lymphocyte ~ 12-15 micrometers) with nucleoli) - surrounded by (2) small dark cells (~ size of resting lymphocyte ~ 8-10 micrometers) - predominant population, lack nucleolus
LM DDx other small cell lymphomas esp. mantle cell lymphoma (IHC similar)
IHC CD20 +ve, CD23 +ve, CD5 +ve, cyclin D1 -ve, CD43 +ve
Site blood + bone marrow/lymph nodes
Prevalence common
Blood work elevated WBC (≥5 × 109/L)
Prognosis good
Treatment often followup

General

  • Very common.
  • Good prognosis - treatment may be simply followup.[1]
    • May transform to an aggressive lymphoma - see below.
  • Older individuals.
  • Elevated WBC ≥5 × 109/L - required for diagnosis (clinically).[2]

Richter's transformation

  • CLL/SLL may under go a Richter's transformation into a high-grade non-Hodgkin's lymphoma (NHL), e.g. DLBCL:[3]
    • Incidence of transformation <5%.
    • Prognosis < 1 year.

Microscopic

Features in a lymph node:[4]

  • Mixed population of lymphoid cells with "proliferation centers" - key feature:
    1. Larger cells (~ 1.5x the size of resting lymphocyte ~ 12-15 micrometers):
      • Nucleoli.
      • Form (nodular) collections.
    2. Small dark cells (~ size of resting lymphocyte ~ 8-10 micrometers):
      • Predominant population.
      • Lack nucleolus.

Images

  • CLL - low mag. (WC)

  • CLL - intermed. mag. (WC)

  • CLL - high mag. (WC)

  • CLL - very high mag. (WC)

www:

IHC

  • CD20 +ve.
  • CD5 +ve.
  • CD23 +ve -- occasionally negative.[5]
  • CD43 +ve.

Others:

  • Cyclin D1 -ve.
  • CD38 -ve/+ve.
    • CD38 -ve suggests a good prognosis.[1]

Panel

A basic panel - based on Rizzo and Nassiri:[6]

  • CD5, CD10, BCL6, CD23, cyclin D1.

Additional IHC:

  • CD20, CD3, CD43, BCL2.

Molecular

See also

References

  1. ↑ 1.0 1.1 Guarini A, Gaidano G, Mauro FR, et al. (August 2003). "Chronic lymphocytic leukemia patients with highly stable and indolent disease show distinctive phenotypic and genotypic features". Blood 102 (3): 1035–41. doi:10.1182/blood-2002-12-3639. PMID 12676780.
  2. ↑ Call TG, Norman AD, Hanson CA, et al. (April 2014). "Incidence of chronic lymphocytic leukemia and high-count monoclonal B-cell lymphocytosis using the 2008 guidelines". Cancer. doi:10.1002/cncr.28690. PMID 24711224.
  3. ↑ Tsimberidou AM, Keating MJ (April 2006). "Richter's transformation in chronic lymphocytic leukemia". Semin. Oncol. 33 (2): 250–6. doi:10.1053/j.seminoncol.2006.01.016. PMID 16616072.
  4. ↑ DG. 17 August 2010.
  5. ↑ URL: http://path.upmc.edu/cases/case296/dx.html. Accessed on: 14 January 2012.
  6. ↑ Rizzo, K.; Nassiri, M. (2012). "Diagnostic Workup of Small B Cell Lymphomas: A Laboratory Perspective.". Lymphoma. doi:doi:10.1155/2012/346084.
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