B cell small lymphocytic lymphoma/chronic lymphocytic leukemia

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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

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.

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

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.