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Autor*: Monika Antošová, A. Buliková, J. Kissová
Description:
67-years old female with diagnose CLL/SCLL comes for progression of the disease. Clinical manifestation shows generalised lymphadenopathy, hepatomegaly and splenomegaly, but no autoimmune features like hemolytic anemia or thrombocytopenia. Marked lymphocytosis is in peripheral blood (290 G/l, 97,4% of leukocytes) and also in bone marrow is massive small lymphocytes infiltration according to cytological and histological examination. Flow cytometry finds cells of CD5+, CD10-, CD19+, CD23+ phenotype.
Zařazení*:
Chronic lymphocytic leukaemia/small lymphocytic lymphoma
Přílohy*:
Description: Peripheral blood smear shows small or medium size (upper left) lymphocytes with oval or round nuclei and clumped chromatin, scanty cytoplasm and a regular cellular outline. Cleft nucleus (underneath the centre) is rare in this diagnose. Some prolymphocytes can occur (at the centre), they have prominent nucleolus and more abundant cytoplasm (4% of leukocytes in this case). 
Description: Bone marrow is hypercellular with infiltration by uniform population of mature, small lymphocytes (smaller magnification). They represent 97,2 % of all nucleated cells in the smear. 
Description: Small lymphocytes in CLL use to have round or oval nucleus in excentric position in the cell. Nuclear chromatin is mature, nucleoli are indistinct or absent. Cytoplasm is pure, weakly basophilic, agranular, rarely with some vacuoles (in the middle). Broken cells or smudge cells are characteristic. 
Description: Small lymphocytes with mature nuclear chromatin, invisible nucleoli and scanty cytoplasm without granulation represent predominant population in bone marrow. The typical feature are also nuclear shadows. 
Description: Numerous small lymphocytes and one segmented neutrophil (at 6 o'clock). Broken cell are typically seen in the smears. They are characteristic but nor pathognomic since they are occasionally seen in a variety other conditions. But only in CLL they are known as "Gumprecht's shades". 
Description: Some lymphocytes can be larger than small especially in advanced cases (above the centre). Oval or round nuclei can have small central depression at one side occasionally (cell to the left from the centre), there is more abundant cytoplasm here. 
Description: Three small and one middle size lymfocytes. There is one prolymphocyte in the middle - it is larger cell with more abundant cytoplasm all around the nucleus, it has prominent nucleolus, chromatin is rather mature. Few nuclear shades. 
Description: Small mature lymphocytes with clear cytoplasm, which contains few vacuoles. There is one prolymphocyte at the middle right. Few typical broken cells.