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Chronic Leukemias
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Scott J. Graham, James D. Cotelingam
Prolymphocytes are larger than small lymphocytes. The nuclei are round to oval, central or eccentric, have mature chromatin, and a single prominent central nucleolus. The cytoplasm is light blue and moderately abundant (Fig. 2). The presence of >55% prolymphocytes in peripheral blood helps distinguish de-novo PLL from CLL and CLL/PLL.
Bone Marrow
Published in Wojciech Gorczyca, Atlas of Differential Diagnosis in Neoplastic Hematopathology, 2014
Prolymphocytes (Figure 2.26A) are larger than lymphocytes, with a moderate amount of cytoplasm, round or occasionally irregular nuclei, and focally prominent nucleoli. FL is characterized by cleaved cells or centrocytes (Figure 2.26B). HCL (Figure 2.26C) is characterized by medium-sized round lymphocytes with cytoplasmic “hairy” projections and round or coffee-bean-shaped nuclei with evenly dispersed chromatin. Irregular or bipolar cytoplasmic projections may also be seen in splenic lymphoma with villous lymphocytes (Figure 2.26D). Large lymphoid cells (Figure 2.26E) have irregular nuclei, an increased nuclear/cytoplasmic ratio, and occasionally prominent nucleoli. T-cell lymphoproliferations (Figure 2.26F–I) are characterized by prominent nuclear contour irregularities, with occasional flower-like cells. T prolymphocytes have prominent nucleoli (Figure 2.26G) and LGLs have coarse azurophilic granules in the cytoplasm (Figure 2.26H). Lymphoblasts (Figure 2.26J) have a scanty cytoplasm, a medium-sized nucleus with delicate evenly distributed chromatin, and one or more inconspicuous nucleoli. Monocytosis in the peripheral blood may be associated with numerous reactive conditions and clonal disorders, including acute monoblastic leukemia (Figure 2.26K) and CMML. The presence of immature erythroid precursors (erythroblastosis; Figure 2.26L) with prominent dyserythropoiesis may be seen in MDS or AEL. In the pediatric age group, erythroblasts in the peripheral blood may be seen in erythroblastosis fetalis (Figure 2.26M) or transient myeloproliferative disorders. In the latter, circulating erythroblasts are accompanied by megakaryocytes and large platelets. A few erythroblasts may be present normally in the peripheral blood of newborn infants. Circulating erythroid precursors mixed with leftward shifted myeloid cells (leukoerythroblastosis; Figure 2.26N) are seen in a variety of reactive conditions as well as MPN and myelophthisic processes. Neutrophilia (Figure 2.26O) with a leftward shift accompanied by eosinophilia and basophilia is seen in CML. Plasma cells in the peripheral blood (Figure 2.26P) may indicate an aggressive or advanced PCM; plasma cell leukemia is characterized by a leukocyte differential with >20% plasma cells. The presence of “leukemic” carcinoma in the peripheral blood is rare (Figure 2.26Q). Erythrophagocytosis by immature cells is most often seen in acute monoblastic leukemia (Figure 2.26R) but can also be seen in other types of acute leukemias.
The prognostic effect on childhood acute lymphoblastic leukemia of CD34+CD38− expressed in leukemia cells
Published in Hematology, 2022
Jiou Zhao, Yun Wang, Min Zhou, Jizhao Gao, Yufang Yuan
Based on China’s Recommendations for diagnosis and treatment of acute lymphoblastic leukemia in childhood (4rd revised version), risk factors that are definitely related to the prognosis of childhood ALL include (1) age at diagnosis of <1 year or ≥10 years; (2) peripheral blood white blood cell (WBC) count >50×109/L at diagnosis; (3) CNSL or TL at time of diagnosis; (4) T-ALL immunophenotype; (5) cellular and molecular biological characteristics of a low diploid with chromosome number <45, t(9;22)(q34;q11.2)/BCR-ABL1, t(4;11)(q21;q23)/MLL-AF4 or other MLL gene rearrangements, or t(1;19)(q23;p13)/E2A-PBX1; (6) prednisone treatment ineffective; (7) bone marrow primitive and naive lymphocytes ≥25% on the 15th day of induction remission; (8) at end of induction remission treatment (day 33 of chemotherapy), bone marrow did not show complete remission, with >5% primitive and prolymphocytes; and (9) MRD ≥1×10−4 at the end of induction remission treatment (day 33 of chemotherapy) or ≥1×10−3 before the start of consolidation therapy (week 12).
Minimal residual disease in chronic lymphocytic leukemia: A consensus paper that presents the clinical impact of the presently available laboratory approaches
Published in Critical Reviews in Clinical Laboratory Sciences, 2018
Ciprian Tomuleasa, Cristina Selicean, Sonia Cismas, Anca Jurj, Mirela Marian, Delia Dima, Sergiu Pasca, Bobe Petrushev, Vlad Moisoiu, Wilhelm-Thomas Micu, Anna Vischer, Kanza Arifeen, Sonia Selicean, Mihnea Zdrenghea, Horia Bumbea, Alina Tanase, Ravnit Grewal, Laura Pop, Carmen Aanei, Ioana Berindan-Neagoe
The final step in CLL diagnosis consists of cytogenetic and molecular genetic analysis of the malignant clone. Some of the more frequent chromosome abnormalities are del (13q), trisomy 12, 11q-, del 6q, and 17p-. Deletions of 13q, especially 13q14 are found in most patients with CLL. Several genes are located in this region and are thus affected by the deletion. Some of these important genes include DLEU1, DLEU2, DLEU6, DLEU7, DLEU8, RFP2, KCNRG, ARLTS1, microRNA-15, and microRNA-16–1 [45–53]. Chromosome 12 abnormalities are represented by chromosome 12 trisomy, which induces an increased expression of genes located on this chromosome. For this disease, the sequences located between 12q13 and 12q22 are especially important. This anomaly is rarely detectable at diagnosis, but is present in more advanced stages of the disease and is also associated with more prominent aneuploidy, thus giving rise to arguments that this is an additional anomaly [54–56]. Chromosome 11 abnormalities are represented by deletions of the long arm of chromosome 11. One of the most important genes for this disease found in this region is ataxia telangiectasia mutated (ATM), which plays a role in DNA damage detection and induction of cell cycle arrest. Patients with this deletion present with a more aggressive form of the disease and resistance to genotoxic agents [57–60]. Chromosome 6 abnormalities are represented by deletions of the band 6q23 and are associated with abnormal morphology of the lymphocytes, higher number of prolymphocytes in the peripheral blood, higher expression of CD38 and lower survival [61–64]. Chromosome 17 abnormalities are represented by the deletion of the short arm of chromosome 17. One of the most important genes located in this region is TP53, which, along with other functions, is implicated in the DNA damage detection pathway and cell cycle arrest. Deletions of this gene are associated with resistance to first-line therapy [65–67].
Diagnostic and therapeutic challenges in hairy cell leukemia-variant: where are we in 2021?
Published in Expert Review of Hematology, 2021
The blood picture in HCL-V is monomorphic. The neoplastic lymphocytes are medium to large sized and have an abundant mildly basophilic cytoplasm with fine projections resembling that of typical hairy cells. The nucleus has a prominent vesicular nucleolus, a condensed non-clumped chromatin, and a regular outline similar to that of prolymphocytes; a few cells with a bilobed nucleus may be present but constitute a very minority [6,15,16].