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Discussion Starter · #1 ·
A 60-year-old male presents with malaise. An irregular finding on his CBC leads to a more detailed workup. Flow cytometry of a blood sample reveals a preponderance of cells expressing CD5, CD19, CD20, and CD23. The patient is most likely to have:
  • Adult T-cell leukemia
  • Anaplastic ALK+ large-cell lymphoma
  • Chronic lymphocytic leukemia
  • Chronic myelogenous leukemia
  • Peripheral T-cell lymphoma
 

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C) Chronic lymphocytic leukemia

My Ans is C) Chronic lymphocytic leukemia

In CLL, the lymphocytes are genetically clonal, of the B cell lineage (express marker molecules cluster of differentiation 19 (CD19) and CD20), and characteristically express the marker molecules CD5 (T-cell marker) and CD23.

As FrontalBossing mentioned above, CLL is more common in elderly.

Ref:


 

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Discussion Starter · #5 ·
Correct!

Perfect answers, FrontalBossing, ms.med, and aktorque! The immunophenotype given is characteristic of chronic lymphocytic leukemia (C), as shown above in aktorque's excellent diagram.

We can also guess the answer based on the knowledge that CD19, CD20, and CD23 are primarily B-cell associated, and all the other choices listed arise from T-cell (A,B, and E) or myeloid (D) precursors. While CD5 is primarily associated with T cells, it is also present on a small subset of B cells.

:)
 

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Hello Mondoshawan! I'm going to share a slide that is typical for CLL. I assume that you don't mind if I share this with others. lol.



A CLL cell is only slightly larger than a red blood cell and shows clumped chromatin, sometimes likened to a "soccer ball." However, atypical CLL cells may not show this chromatin clumping and diagnosis can only be made using immunophenotyping.
 

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Discussion Starter · #7 ·
Nice slide! I've never seen that before - thanks!

Edit: wait a second... Are you sure? I was curious ("soccer balls? :notsure: ), so I went looking for more of them, but all the soccer ball CLL pics I saw looked more like this one:



what do you think?
 

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Another thing to keep in mind in the diagnosis of SLL/CLL, if they don't give you the CD5/CD 23 in the vignette, they may describe a neoplasm in the elderly with cells that easily lyse or they'll describe them as "fragile" and in this case they are talking about the smudge cells.

Hereditary Spherocytosis will most definitely be an answer choice. . . the wrong answer choice.
 

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Nice slide! I've never seen that before - thanks!

Edit: wait a second... Are you sure? I was curious ("soccer balls? :notsure: ), so I went looking for more of them, but all the soccer ball CLL pics I saw looked more like this one:

what do you think?
Yes, you are absolutely right. The one I got is similar in appearance, but your slide has more likely a "soccer ball" appearance. Thanks for pointing it out.
 
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