We have a very interesting case. An 80 year old gentleman with a WBC= 47 K/uL and a working diagnosis of CLL sought another opinion. We found his tumor cells to be negative for CD5 and CD23. They had Bright CD19, CD20, CD22 and surface kappa. They were positive for CD103, FMC7 & and CD11c, although the CD11c was not the bright staining characteristic of hairy cell and CD25 was negative. Also- cells were negative for CD38 and CD10 but + for CD79 and CD24. The specimen was a submitted heparinized tube- no fresh smear. We have found that cells sitting in heparin for awhile have poor nuclear features after smearing and staining. However, the cells have copius cytoplasm. Borders may be curled, indistinct, possibly hairy but maybe not. We feel that this is most consistent with atypical hairy cell. The diagnosis of CLL was never confirmed by immuno studies- just a low grade lymphoid leukemia- and I feel the diagnosis is wrong. The clinician asked if this could be PLL. Has any one ever seen really good staining with CD103 in PLL? Maryalice Maryalice Stetler-Stevenson Director Flow Cytometry Unit Laboratory of Pathology, NCI, NIH "Learn the rules so you know how to break them properly." The Dalai Lama
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