Difference between revisions of "B cell small lymphocytic lymphoma/chronic lymphocytic leukemia"

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'''B cell small lymphocytic lymphoma/chronic lymphocytic leukemia''', often referred to as '''chronic lymphocytic leukemia''' (abbreviated '''CLL''') or '''small lymphocytic lymphoma''' (abbreviated '''SLL'''), is a common low-grade hematologic [[malignancy]]. That typically afflicts older individuals.
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Chronic lymphocytic leukemia - low mag.jpg
| Width      =
| Caption    = Small lymphocytic lymphoma. [[H&E stain]].
| Synonyms  =
| Micro      = mixed population of lymphoid cells with "proliferation centers": (1) nodular collections of larger cells (~ 1.5x the size of resting lymphocyte ~ 12-15 micrometers) with nucleoli) - surrounded by (2) small dark cells (~ size of resting lymphocyte ~ 8-10 micrometers) - predominant population, lack nucleolus
| Subtypes  =
| LMDDx      = other [[small cell lymphomas]] esp. [[mantle cell lymphoma]] (IHC similar)
| Stains    =
| IHC        = CD20 +ve, CD23 +ve, CD5 +ve, cyclin D1 -ve, CD43 +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = blood + [[bone marrow]]/[[lymph nodes]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = common
| Bloodwork  = elevated WBC (≥5 × 10<sup>9</sup>/L)
| Rads      =
| Endoscopy  =
| Prognosis  = good
| Other      =
| ClinDDx    =
| Tx        = often followup
}}
'''B cell small lymphocytic lymphoma/chronic lymphocytic leukemia''', often referred to as '''chronic lymphocytic leukemia''' (abbreviated '''CLL''') or '''small lymphocytic lymphoma''' (abbreviated '''SLL'''), is a common low-grade hematologic [[malignancy]]. It typically afflicts older individuals.


==General==
==General==
*Very common.
*Very common.
*Good prognosis.
*Good prognosis - treatment may be simply followup.<ref name=pmid12676780>{{cite journal |author=Guarini A, Gaidano G, Mauro FR, ''et al.'' |title=Chronic lymphocytic leukemia patients with highly stable and indolent disease show distinctive phenotypic and genotypic features |journal=Blood |volume=102 |issue=3 |pages=1035–41 |year=2003 |month=August |pmid=12676780 |doi=10.1182/blood-2002-12-3639 |url=}}</ref>
**May transform to an aggressive lymphoma - see below.
*Older individuals.
*Elevated WBC ≥5 × 10<sup>9</sup>/L - required for diagnosis (clinically).<ref>{{cite journal |author=Call TG, Norman AD, Hanson CA, ''et al.'' |title=Incidence of chronic lymphocytic leukemia and high-count monoclonal B-cell lymphocytosis using the 2008 guidelines |journal=Cancer |volume= |issue= |pages= |year=2014 |month=April |pmid=24711224 |doi=10.1002/cncr.28690 |url=}}</ref>


===Richter's transformation===
===Richter's transformation===
Line 40: Line 74:
Others:
Others:
*Cyclin D1 -ve.  
*Cyclin D1 -ve.  
*CD38 -ve/+ve.
**CD38 -ve suggests a good prognosis.<ref name=pmid12676780>{{cite journal |author=Guarini A, Gaidano G, Mauro FR, ''et al.'' |title=Chronic lymphocytic leukemia patients with highly stable and indolent disease show distinctive phenotypic and genotypic features |journal=Blood |volume=102 |issue=3 |pages=1035–41 |year=2003 |month=August |pmid=12676780 |doi=10.1182/blood-2002-12-3639 |url=}}</ref>
===Panel===
A basic panel - based on ''Rizzo and Nassiri'':<ref name=lymphoma>{{Cite journal  | last1 = Rizzo | first1 = K. | last2 = Nassiri| first2 = M. | title = Diagnostic Workup of Small B Cell Lymphomas: A Laboratory Perspective. | journal = Lymphoma | volume =  | issue =  | pages =  | month =  | year = 2012 | doi =doi:10.1155/2012/346084| PMID = }}</ref>
*CD5, CD10, BCL6, CD23, cyclin D1.
Additional IHC:
*CD20, CD3, CD43, BCL2.


==Molecular==
==Molecular==

Latest revision as of 15:16, 13 August 2015

B cell small lymphocytic lymphoma/chronic lymphocytic leukemia
Diagnosis in short

Small lymphocytic lymphoma. H&E stain.
LM mixed population of lymphoid cells with "proliferation centers": (1) nodular collections of larger cells (~ 1.5x the size of resting lymphocyte ~ 12-15 micrometers) with nucleoli) - surrounded by (2) small dark cells (~ size of resting lymphocyte ~ 8-10 micrometers) - predominant population, lack nucleolus
LM DDx other small cell lymphomas esp. mantle cell lymphoma (IHC similar)
IHC CD20 +ve, CD23 +ve, CD5 +ve, cyclin D1 -ve, CD43 +ve
Site blood + bone marrow/lymph nodes
Prevalence common
Blood work elevated WBC (≥5 × 109/L)
Prognosis good
Treatment often followup

B cell small lymphocytic lymphoma/chronic lymphocytic leukemia, often referred to as chronic lymphocytic leukemia (abbreviated CLL) or small lymphocytic lymphoma (abbreviated SLL), is a common low-grade hematologic malignancy. It typically afflicts older individuals.

General

  • Very common.
  • Good prognosis - treatment may be simply followup.[1]
    • May transform to an aggressive lymphoma - see below.
  • Older individuals.
  • Elevated WBC ≥5 × 109/L - required for diagnosis (clinically).[2]

Richter's transformation

  • CLL/SLL may under go a Richter's transformation into a high-grade non-Hodgkin's lymphoma (NHL), e.g. DLBCL:[3]
    • Incidence of transformation <5%.
    • Prognosis < 1 year.

Microscopic

Features in a lymph node:[4]

  • Mixed population of lymphoid cells with "proliferation centers" - key feature:
    1. Larger cells (~ 1.5x the size of resting lymphocyte ~ 12-15 micrometers):
      • Nucleoli.
      • Form (nodular) collections.
    2. Small dark cells (~ size of resting lymphocyte ~ 8-10 micrometers):
      • Predominant population.
      • Lack nucleolus.

Images

  • CLL - low mag. (WC)

  • CLL - intermed. mag. (WC)

  • CLL - high mag. (WC)

  • CLL - very high mag. (WC)

www:

IHC

  • CD20 +ve.
  • CD5 +ve.
  • CD23 +ve -- occasionally negative.[5]
  • CD43 +ve.

Others:

  • Cyclin D1 -ve.
  • CD38 -ve/+ve.
    • CD38 -ve suggests a good prognosis.[1]

Panel

A basic panel - based on Rizzo and Nassiri:[6]

  • CD5, CD10, BCL6, CD23, cyclin D1.

Additional IHC:

  • CD20, CD3, CD43, BCL2.

Molecular

See also

References

  1. ↑ 1.0 1.1 Guarini A, Gaidano G, Mauro FR, et al. (August 2003). "Chronic lymphocytic leukemia patients with highly stable and indolent disease show distinctive phenotypic and genotypic features". Blood 102 (3): 1035–41. doi:10.1182/blood-2002-12-3639. PMID 12676780.
  2. ↑ Call TG, Norman AD, Hanson CA, et al. (April 2014). "Incidence of chronic lymphocytic leukemia and high-count monoclonal B-cell lymphocytosis using the 2008 guidelines". Cancer. doi:10.1002/cncr.28690. PMID 24711224.
  3. ↑ Tsimberidou AM, Keating MJ (April 2006). "Richter's transformation in chronic lymphocytic leukemia". Semin. Oncol. 33 (2): 250–6. doi:10.1053/j.seminoncol.2006.01.016. PMID 16616072.
  4. ↑ DG. 17 August 2010.
  5. ↑ URL: http://path.upmc.edu/cases/case296/dx.html. Accessed on: 14 January 2012.
  6. ↑ Rizzo, K.; Nassiri, M. (2012). "Diagnostic Workup of Small B Cell Lymphomas: A Laboratory Perspective.". Lymphoma. doi:doi:10.1155/2012/346084.
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