|
Autor*: Monika Antošová, A. Buliková, J. Kissová
Description:
80-years old patient with clinical manifestation of splenomegaly but no lymphadenopathy. In CBC is high leukocytosis (111G/l), mild anaemia (123 g/l) and thrombocytopenia (119G/l). Peripheral blood and bone marrow smears show "villous" lymphocytes, flow cytometry lymphocytes of phenotype CD5-, CD19+, CD20+, CD22+, CD23-, CD38+, lambda+. The most probable diagnose is splenic marginal zone lymphoma, but patient refuses hospitalization for diagnose confirmation, staging of the disease and treatment.
Zařazení*:
Splenic marginal zone lymphoma
Přílohy*:
Description: Lymphoma cell with short polar villi in peripheral blood smear (fresh capillary blood smear). Cells are larger than normal small lymphocyte with round to oval nucleus. There are not seen clear nucleoli here. 
Description: Another example of "villous lymphocytes" in peripheral blood smear (without EDTA). Cytoplasm of the lymphoma cells is quite basophilic. One segmented eosinophil at the middle left. 
Description: In this thinner part of the smear lymphoma cells are better seen in details. Cells have moderately condensed chromatin, nucleoli are rather inconspicuous in this case. Cytoplasm is basophilic with clear projections (two cells at the lower left). 
Description: "Villous lymphocyte" in detail. Rather abundant basophilic cytoplasm with few projections at two opposite sides of the cell. One poorly seen nucleolus is at the lower part of nucleus. Cytoplasm contains some vacuoles and one cytoplasmic inclusion. 
Description: Middle size cells with rather abundant cytoplasm with villi. When one compare there cells with tumour cells of hairy cell leukaemia, they have more basophilic cytoplasm and cytoplasmic projections are more thick and less numerous. 
Description: Numerous villous lymphocytes in bone marrow smear. Some show nucleoli in their nuclei. There is segmented neutrophil underneath the centre of the picture and one large granular lymphocyte at 5 o' clock. 
Description: Massive bone marrow infiltration by lymphoma cells. Their nuclei have condensed chromatin, about half of the cells express small nucleolus. Only very few of the cells are more immature ones (cell in the middle at 3 o'clock) with more immature chromatin and high N/C ratio. Cytoplasm of the most tumour cells have some projections. 
Description: The most of lymphocytes in the picture belong to lymphoma cells. But that one at 5 o'clock is large granular lymphocyte (LGL) - it means NK cell or mature T lymphocyte. Also lymphocyte at 4 o'clock does not seems to be lymphoma cell. It can be reactive lymphocyte according to pale cytoplasm with more basophilic rim. 
Description: In bone marrow smears usually villous lymphocytes are less evident than in peripheral blood smears especially when they are made from fresh blood. The picture shows a group of medium size lymphocytes with blue cytoplasm, but cytoplasmic projections are less pronounced. 
Description: Three lymphoma cells with round or oval nuclei and small nucleoli. Cytoplasmic blebs are evident especially in the cell at the upper right. 
Description: Four lymphoma cells. The cell at upper left has cleft nucleus or one can say that it is
binuclear; chromatin of this cell shows more coarse clumping (more immature) and there is prominent nucleolus at the upper part of the nucleus.