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1556 Part XI: Malignant Lymphoid Diseases Chapter 93: Hairy Cell Leukemia 1557

10 3
1023 G1 0.0% G2 3.1%

10 2
Monos
1.8%
SS Lin CD19-ECD 10 1

10 0
G3 G4
Blasts 0.8%
0.0% Lymphs 96.1%
33.7%
0
10 0 10 1 10 2 10 3 10 0 10 1 10 2 10 3
CD45-PC7 CD20-FITC
10 3 10 3
F1 F2 G1 G2
1.9% 2.7% 0.5% 2.6%
O
10 2 2.7% 10 2
CD25-PC5 10 1 CD19-ECD 10 1

10 0 10 0
F3 F4 G3 G4
95.0% 0.4% 95.8% 1.1%
10 0 10 1 10 2 10 3 10 0 10 1 10 2 10 3
CD19-ECD CD103-FITC
10 3 10 3
D1 D2 D1 D2
8.3% 2.9% 8.9% 2.9%
10 2 10 2
CD11c-PE 10 1 CD123-PE 10 1

10 0 10 0
D3 D4 D3 D4
88.6% 0.2% 87.9% 0.3%
10 0 10 1 10 2 10 3 10 0 10 1 10 2 10 3
CD19-ECD CD19-ECD
10 3 10 3
F1 F2 C1 C2
76.5% 0.1% 0.1% 5.5%
10 2 10 2
CD27-PC5 10 1 Lambda-PE 10 1 AJ 0.1%

10 0 10 0 AK
F3 F4 C3 C4 13.9%
20.3% 3.0% 81.9% 12.6%
10 0 10 1 10 2 10 3 10 0 10 1 10 2 10 3
CD19-ECD Kappa-FITC
Figure 93–1. Hairy cell leukemia (HCL) immunophenotypic profiling should be performed using multiparametric flow cytometry analysis. Both
blood and hemodilute marrow aspirates should be analyzed regardless of the number of leukemic cells seen on morphologic review of slides.
Because of a very characteristic immunophenotype, definitive diagnosis of HCL can be rendered based on flow cytometric data even with a very low
number of leukemic cells. As a result of their complex surface projections, hairy cells demonstrate moderate to high side scatter (SC) characteristics
resulting in their shift on flow plots into the region typically occupied by monocytes. Hairy cells are positive for CD11c+, CD19+, CD20+, CD25+,
CD103+, CD123+ and show κ light-chain restriction in this example. Hairy cells are negative for CD27−. Very rare cases of HCL may show positive
staining for CD5 or CD10 antigens. It is important to note that while atypical, the expression of these antigens does not preclude a definitive diagnosis
of HCL in cases with otherwise typical HCL immunophenotype.

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