Page 432 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

Case studies NOTE:

Analyze the patient history, clinical signs and symptoms, and labo- ■ indicates MLT and MLS core content

ratory data for the stated case studies; answer the related critical indicates MLT (optional) and MLS advanced content

thinking questions; and conclude the most likely diagnosis.

LEUKEMIAS VERSUS LYMPHOMAS NOTE: This is a good time to review the de nitions of the Key

Terms in the Glossary and ash cards on .

T e ter ly phoproli er tive isor er inclu es the v rious
or s o leukemias n lymphomas th t re o ly phoreticu-

l r origin. Ly phoi neopl s cl ssif c tions re b se on
the istribution o ise se s leuke i or ly pho . T e CHRONIC LYMPHOCYTOSIS

neopl stic cells o leuke i n ly pho h ve n inti te
rel tionship. Frequently, the neopl stic cells o these two is- Tere re v rious con itions th t pro uce chronic ly -

or ers re i entic l ( ble 22.1). phocytosis (Box 22.1). T ese con itions c n be benign
Leuke i s represent overproli er tion or ccu ul tion or lign nt n involve either or B ly phocytes. T e

o he topoietic cells in the circul ting bloo n /or bone lign nt con itions th t ust be consi ere in the i -
rrow. During the progression o ise se in so e ly - erenti l i gnosis o chronic lymphocytic leukemia (CLL)

pho s, the lign nt cells y spill into the bloo circu- re lign nt B- n -cell isor ers s well s spillover
l tion. T is spillover y pro uce leuke ic ph se o the leuke ic ph se o so e c ses o non-Hodgkin lymphoma

ise se. r nsitions to leuke ic ph se re r re in isor ers (NHLs).
such s Hodgkin disease but re not unco on in the well-

i erenti te non-Ho gkin ly phocytic ly pho s. In the Chronic Lymphocytic Leukemia (CLL)/ Small
l bor tory, bone rrow n peripher l bloo speci ens re Lymphocytic Lymphoma (SLL)

stu ie by icroscopic ex in tion, ow cyto etry, cyto- Chronic leuke i s re gener lly ch r cterize by the pres-
che ic l st ining, n chro oso e n olecul r n lysis. ence o leukocytosis with n incre se nu ber o ture

T e requency o ex in tion o bone rrow n periph- ly phocytes, ly phocytosis, on peripher l bloo f l .
er l bloo involve ent epen s on the ly pho subtype. For ex ple, lign nt ly phoproli er tive isor ers

Ly pho s re heterogeneous group o closely rel te ( ble 22.2) re ch r cterize by n ccu ul tion o
isor ers th t re ch r cterize by the overproli er tion o ly phocytes.

one or ore types o cells o the ly phoi syste such s Both CLL n SLL re neopl s s co pose o s ll B
ly phoreticul r ste cells, ly phocytes, reticulu cells, ly phocytes in the peripher l bloo , bone rrow, spleen,

n histiocytes. Ly pho s re lign nt neopl s s th t n ly ph no es, ixe with proly phocytes n p r -
involve ly phoi org ns or tissues, inclu ing ly ph no es. i unobl sts or ing proli er tion centers in tissue inf l-

Stu y o ly phoi tissue ss or ly ph no e is per or e tr tes. In contr st to CLL, SLL is use or nonleuke ic
by obt ining speci en ro biopsy or f ne-nee le spi- p tients with the tissue orphology n i unopheno-

r te o ss. An lysis o speci en is by icroscopic type o CLL.
ex in tion, ow cyto etry, cytoche ic l st ining, n

chro oso e n olecul r n lysis.

Relationship of Leukemias and BOX 22.1
TABLE 22.1
Lymphomas

Examples of World Health Organization of
Leukemia Type Solid Tumor Counterpart
Mature B-Cell Neoplasms

Stem cell leukemia Lymphoma, undifferentiated
Chronic ly phocytic leuke i /s ll ly phocytic leuke i

Acute lymphoblastic Lymphoma, poorly leukemia B-cell proly phocytic leuke i

differentiated; lymphocytic H iry cell leuke i

Pl s cell yelo
Chronic lymphocytic Lymphoma, well leukemia

differentiated; lymphocytic Monoclon l g op thy o un eter ine signif c nce
(MGUS)

Monocytic leukemia Reticulum cell sarcoma Pri ry yloi osis

He vy ch in ise ses
Acute myelogenous Chloroma granulocytic leukemia
Burkitt ly pho /leuke i
Plasma cell leukemia Myeloma