1. MLAB 1415- Hematology Keri Brophy-Martinez
Chapter 26: Lymphoid Malignancies:
Chronic Lymphoid Leukemias
Lymphomas
Plasma Cell Neoplasms

2. Introduction
Divided into four categories based on maturity of neoplastic cells and distribution of disease
Acute lymphoblastic leukemia
Proliferation of blasts belonging to lymphoid lineage
Chronic leukemic lymphoid malignancies
Mature lymphocytes, insidious onset, indolent course
Malignant lymphoma
Tumor masses involving lymphoid organs
Plasma cell neoplasms
Involvement of immunoglobulin-secreting cells

3. Pathogenesis Acquired genetic factors Inherited genetic factors
Proto-oncogenes
Tumor suppressor genes
Inherited genetic factors
Wiskott Aldrich
Ataxia telangiectasia
Environmental factors
EBV infection
Helicobacter pylori

4. Chronic Lymphocytic Leukemia
General requirements for diagnosis
Peripheral blood (>5000 ALC) and bone marrow lymphocytosis (>30%)
Lymphocytes are small to slightly larger than normal with mature appearance
Nucleus is round, with block-type chromatin
Cytoplasm scarce
Smudge cells (bare nuclei) are common
Occur due to the cell’s fragility in making a smear
Prolymphocyte < 10%

5. CLL Blood Picture

6. Chronic Lymphocytic Leukemia
Clinical features
Occurs in persons >50 years old
Men are affected more than women 2:1
Chronic fatigue, infection
Result of bone marrow replacement of normal cells with lymphocytes.
Skin and organ infiltration and enlargement
Median survival is 4-5 years, with 30% of patients surviving 10 years

7. Chronic Lymphocytic Leukemia
Treatment
Usually treatment is not required until lymphocytosis causes other cells to be crowded out resulting in infections.
Treatment depends on the stage at which the disease is diagnosed and is usually for the symptoms, not the disease.
Radiation of localized infiltration
Chemotherapy given according to stage of disease
IV gamma globulin for prevention of infection
Bone marrow transplant done on aggressive cases

8. Hairy cell leukemia (HCL)
Presents in middle age
Affects males7:1 over females
Pancytopenia common
Increases opportunity for infections
Bone marrow aspirate can result in a “dry tap” due to marrow fibrosis.
Hairy cell leukemia can be treated with a one-time chemotherapy regimen with a good prognosis of long-term survival.

9. Hairy cell
TRAP stain

10. T cell Neoplasms
Large Granular Lymphocyte Leukemia
Sezary’s Syndrome

11. Large Granular Lymphocyte Leukemia (LGLL)
Moderate lymphocytosis
Abundant pale blue cytoplasm
Azurophilic granules
Clumped chromatin in nuclei
Anemia
Neutropenia
Thrombocytopenia

12. Sezary’s syndrome
Leukemic phase of the most common cutaneous T-cell lymphoma, mycosis fungoides.
Diagnosis is confirmed by skin biopsy and presence of Sézary cells.

13. Sezary Cell

14. References
McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory Hematology . Upper Saddle River: Pearson Education, Inc.