PART TWO
Diagnostic Cytology
A
CL
CD
-Q
CD
06078.008
|
i i IInil|
l l IIMM|
.......... .
............
100
101
102
103
104
Kappa FITC
B 104
103
06078.008
Kappa FITC
06078.008
C
104|
103
Lambda PE
D
CL
o
<55
Q .
O
CNJ
o
o
104
E
103
102
CD10 FITC
06078.009
104
103
CL
o
CD5 PE
06078.009
F
104
G
104
100
1 01
102
1 03
1 04
100
1 01
102
1 03
1 04
CD79a FITC
CD23 PF
Fig. 24.25 Small lymphocytic lymphoma/chronic lymphocytic leukemia, flow cytometry.
(A) Kappa to lambda ratio 15:1. (B and C)
Kappa-restricted CD19+ B cells. (D) Dim CD20 and no CD10 expression. (E) CD5 coexpression. (F) Negative CD79a expression.
(G) CD23 coexpression.
• Light-chain restriction (low intensity);
• Molecular and cytogenetic prognostic categories; and
• Important differential diagnosis with MCL.
Lym phoplasm acytic Lymphoma/W aldenstrom
M acroglobulinem ia
Clinical
Lym phoplasm acytic lym p h o m a /W M is an u nc om m o n low-grade
B-cell m alignancy com prising ab out 2 -3 % o f all NHLs. The
clinical course is generally in d o le n t b u t tra nsfo rm a tion to LCL
occurs in 5 -1 0 % o f cases. It is a disease o f the elderly, and patients
m ay present w ith sym ptom s s im ila r to SLL w ith generalized
lym p had enop athy som etim es accompanied by splenomegaly. The
m a jo rity o f patients present w ith sym ptom s o f W M w ith a m o n o -
clonal IgM paraproteinem ia and hyperviscosity syndrom e.135
Cytomorphology
Lym phoplasm acytic ly m p h o m a /W M consists o f a m ixed p op u-
la tio n o f sm all lym phocytes, plasm acytoid lym phocytes, plasm a
cells, and scattered plasm acytoid im m un ob la sts (Fig. 2 4.2 8 ).
Periodic acid-Schiff-positive intra nu clea r inclusions (D utcher
bodies) m ay be seen in the plasm a cells. Cases w ith an increased
n um b er o f im m un ob la sts and m itoses are associated w ith a
m ore aggressive clinical course, a lth ou g h there are no validated
criteria established fo r grading.1
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