MLAB 1415- Hematology

Keri Brophy-MartinezChapter 26: Lymphoid Malignancies: Chronic Lymphoid Leukemias

LymphomasPlasma Cell Neoplasms

Introduction

Divided into four categories based on maturity of neoplastic cells and distribution of disease

Acute lymphoblastic leukemia Proliferation of blasts belonging to lymphoid lineage

Chronic leukemic lymphoid malignancies Mature lymphocytes, insidious onset, indolent course

Malignant lymphoma Tumor masses involving lymphoid organs

Plasma cell neoplasms Involvement of immunoglobulin-secreting cells

Pathogenesis

Acquired genetic factors Proto-oncogenes Tumor suppressor genes

Inherited genetic factors Wiskott Aldrich Ataxia telangiectasia

Environmental factors EBV infection Helicobacter pylori

Chronic Lymphocytic Leukemia General requirements for diagnosis

Peripheral blood (>5000 ALC) and bone marrow lymphocytosis (>30%)

Lymphocytes are small to slightly larger than normal with mature appearance Nucleus is round, with block-type chromatin Cytoplasm scarce

Smudge cells (bare nuclei) are common Occur due to the cell’s fragility in making a smear

Prolymphocyte < 10%

CLL Blood Picture

Chronic Lymphocytic Leukemia Clinical features

Occurs in persons >50 years old Men are affected more than women 2:1 Chronic fatigue, infection

Result of bone marrow replacement of normal cells with lymphocytes.

Skin and organ infiltration and enlargement Median survival is 4-5 years, with 30% of patients

surviving 10 years

Chronic Lymphocytic Leukemia Treatment

Usually treatment is not required until lymphocytosis causes other cells to be crowded out resulting in infections.

Treatment depends on the stage at which the disease is diagnosed and is usually for the symptoms, not the disease. Radiation of localized infiltration Chemotherapy given according to stage of disease IV gamma globulin for prevention of infection Bone marrow transplant done on aggressive cases

Hairy cell leukemia (HCL)

Presents in middle age

Affects males7:1 over females

Pancytopenia common Increases opportunity for infections

Bone marrow aspirate can result in a “dry tap” due to marrow fibrosis.

Hairy cell leukemia can be treated with a one-time chemotherapy regimen with a good prognosis of long-term survival.

Hairy cell

TRAP stain

T cell Neoplasms

Large Granular Lymphocyte Leukemia Sezary’s Syndrome

Large Granular Lymphocyte Leukemia (LGLL) Moderate lymphocytosis Abundant pale blue

cytoplasm Azurophilic granules Clumped chromatin in

nuclei Anemia Neutropenia Thrombocytopenia

Sezary’s syndrome

Leukemic phase of the most common cutaneous T-cell lymphoma, mycosis fungoides.

Diagnosis is confirmed by skin biopsy and presence of Sézary cells.

Sezary Cell

References

• McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory Hematology . Upper Saddle River: Pearson Education, Inc.

• http://www.med-ed.virginia.edu/courses/path/innes/wcd/lympleuk.cfm