From www.bloodjournal.org by guest on September 19, 2019. For personal use only.

work images in hematology

Hairy cell leukemia coexistent with chronic

lymphocytic leukemia
Ivo M. B. Francischetti and Katherine R. Calvo, National Institutes of Health Clinical Center

A B C

200x 1000x

D E F

1000x 1000x 1000x

G H I

500x 1000x 1000x

J K L
10
5
105 105
PerCP-Cy5-5-A CD5

104 104 104

PE-A Lambda
APC-A CD22

103 103
103

102 102
-102
-102 -102
-102 103 104 105 -1020 103 104 105 -1020 103 104 105
PE-Cy7-A CD19 PerCP-Cy5-5-A CD11c FITC-A Kappa
M 90 150 210 270 326 330 390

312 332 POS

6600
RFU

4400 IGH-FR1

2200

0
Amplicon length

A 72-year-old man presents with leukocytosis (30 3 109/L-40 3 cytometry of marrow confirmed 2 clonal B-cell populations: the
109/L) with lymphocytosis (80%), monocytopenia, and anemia first (red) was CD191CD52 (panel J), CD221CD11c1 (panel K),
for 10 years. Peripheral smear revealed cells with cytoplasmic CD201CD251CD1031CD1231CD232 (not shown), and l light
projections and atypical lymphocytes (panel A [Giemsa stain; chain–positive (panel L), diagnostic of HCL. A second population
original magnification 31000]). A bone marrow biopsy showed (magenta) was CD191CD51 (panel J), CD221CD11c2 (panel K),
areas of trilineage hematopoiesis and an interstitial infiltrate of CD201 (moderate) CD231 (spectrum) CD432CD2002CD1032
lymphoid cells (panel B [hematoxylin and eosin (H&E) stain]) with (not shown), and k light chain–positive (panel L), representing
irregular nuclei and ample cytoplasm (panel C [H&E stain]). atypical chronic lymphocytic leukemia. B-cell clonality testing
Immunohistochemistry revealed cells double positive for by immunoglobulin heavy chain polymerase chain reaction
PAX5 (brown) and tartrate-resistant acid phosphatase (red; showed 3 significant peaks (panel M) consistent with 2 distinct
panel D), PAX5 (brown) and CD103 (red; panel E), annexin clonal B-cell populations. The patient was initially treated with
(panel F), and BRAFV600E (panel G) diagnostic of hairy cell leu- splenectomy, and later with trametinib (MEK inhibitor) and
kemia (HCL). A second distinct population dual positive for PAX5 dabrafenib (BRAF inhibitor).
(brown) and CD5 (red; panel H) in combination with LEF-1 (panel
I), and negative for cyclin D1/SOX11, indicated synchronous This case highlights the indolent course of HCL and its recog-
involvement by CD51 lymphoproliferative disorder (LPD). Flow nized association with other B-cell LPD.

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DOI 10.1182/blood-2018-12-885145

1264 blood® 14 MARCH 2019 | VOLUME 133, NUMBER 11

 From www.bloodjournal.org by guest on September 19, 2019. For personal use only.

2019 133: 1264

doi:10.1182/blood-2018-12-885145

Hairy cell leukemia coexistent with chronic lymphocytic leukemia

Ivo M. B. Francischetti and Katherine R. Calvo

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