Hematology Case 41

Presented By Dr Mohammad Moharram

Released on 17-8-2020

Patient Data

72 year old male.

Clinical Data

Patient referred to our hospital due to accidental finding of leukocytosis during investigating his complain of chest pain and shortness of breath.

Generalized lymphadenopathy; left cervical, bilateral axillary and bilateral inguinal lymph nodes are palpable.

No Hepatomegaly or splenomegaly.

No lower limb oedema. Chest and heart auscultation are normal. normal vital data.

CT abdomen : para-aortic and pelvic lymph nodes enlargement.

Related Laboratory Results

  • CBC WBC: 100.6 X 103 /uL - HGB: 12.8 g/dL - MCV: 89.9 fL - MCH: 28.2 pG - MCHC: 31.5% - Platelet: 168 X 103 /uL- Analyzer Differential count (Lymphocytes: 95.1% - Neutrophils: 3.5% - Monocytes: 1.1 - Eosinophils: 0.3%) - Peripheral smear comment → see images and comment below.
  • Normal RFT , LFT.
  • Normal PT and APTT

Provisional Diagnosis

?? Leukemia / Lymphoma

Case Picture(s) / Photo(s)

Peripheral blood smear

Comment / Findings

Peripheral blood smear comment:

Marked Leukocytosis. Severe absolute lymphocytosis.

91% of leukocytes are mature looking lymphocytes (Small size, high nuclear cytoplasmic ratio, dense chromatin no visible nucleoli).

Many smudge cells are seen.

4% Atypical lymphocytes.

Picture of lymphoproliferative disorder. (mostly ?? CLL) to be confirmed by immunophenotyping.

Immunophenotyping report

Immunophenotyping comment

The gated lymphocytes constitutes 92% using FSC/SSC gating strategy. They have immunophenotyping pattern consistent with B-chromic lymphocytic leukemia / Small lymphocytic lymphoma.

Final Diagnosis

B-chromic lymphocytic leukemia / Small lymphocytic lymphoma.