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. Thanks! Francesca
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