Hematopathology, Case 8

A 58 year-old male is seen by his primary care physician for a routine physical examination. Overall, he feels well without complaints. Physical examination is unremarkable except for non-tender cervical and inguinal lymphadenopathy. The spleen is not enlarged.

CBCWBC 6.2x103/mL, Hemoglobin 14.5g/dLHematocrit 44.2%MCV 89.0 femtoliters (fL)Red cell distribution width (RDW) 14.2Platelets 233,000/mL

Describe the low power microscopic findings.

Architecture is effaced by a diffuse infiltrate of cells. Although in some areas the infiltrate appears vaguely nodular, discreet follicles are not seen.

Describe the high power microscopic findings

Infiltrate is predominantly composed of small mature-appearing lymphocytes with generally round nuclei.Diagnosis?Small lymphocytic lymphoma (SLL)

One year later…

• The patient has a CBC drawn:

WBC 39.6 x103/mL Hemoglobin 10.5g/dL Hematocrit 30.2%MCV 86.0 fLRed cell distribution width (RDW) 16.2Platelets 149,000/mL

Describe the findings on the peripheral blood smear

Diagnosis?Chronic lymphocytic leukemia (CLL)

“SmudgeCell”

Small lymphocytesWith scant cytoplasm