Introduction:Since
it is impossible to establish a diagnosis in the presence of hyperlymphocytosis
not secondary to lymphocytic hyperactivation, we considered a B-lymphoid
hematopathy with a non-specific phenotypic profile. We report one case of this. Observation: This is a forty-eight (48) year old patient with
hyperlymphocytosis at 139,000 elements per cubic millimeter, heterogeneous
splenomegaly at 25.6 cm in diameter on abdominal ultrasound without detectable
deep or peripheral lymphadenopathy.Peripheral blood cytology shows lymphocyte
cell proliferation suggestive of the circulating phase of chronic
lymphoproliferative B syndrome. The expression profile of cell membrane markers
did not allow for the definition of a specific phenotypic profile.Faced with this immunophenotyping result, we
considered a B-lymphoid hemopathy with a non-specific phenotypic profile. After
three courses, the MINICHOP treatment was used to achieve partial remission
with wasting of more than 80% of the evaluable masses. Conclusion: Despite the contribution of immunophenotyping in the diagnosis of
lymphoproliferative syndromes, it is possible to consider the diagnosis of a B-lymphoid
hemopathy with a phenotypic non-specific profile of CD45+, monotypic kappa, CD19+, FMC7+, CD22+, CD5？, CD79b？, CD23？,CD43？, CD38？, CD200？.
References
[1]
Craig, F.E. and Foon, K.A. (2008) Flow Cytometric Immunophenotyping for Hematologic Neoplasms. Blood, 111, 3941-3967. https://doi.org/10.1182/blood-2007-11-120535
[2]
De Tute, R.M. (2011) Flow Cytometry and Its Use in the Diagnosis and Management of Mature Lymphoid Malignancies. Histopathology, 58, 90-105. https://doi.org/10.1111/j.1365-2559.2010.03703.x
[3]
Struski, S., et al. (2008) Stimulation of B-Cell Lymphoproliferations with CpG-Oli-gonucleotide DSP30 plus IL-2 is More Effective than with TPA to Detect Clonal Abnormalities. Leukemia, 23, 617-619. https://doi.org/10.1038/leu.2008.252
[4]
Struski, S., et al. (2007) A Cytological, Immunophenotypic and Cytogenetical Study of 136 Consecutive Cases of B-Cell Chronic Lymphoid Hemopathies. Pathologie Biologie (Paris), 55, 59-72. https://doi.org/10.1016/j.patbio.2006.04.006
[5]
Harris, N.L., Jaffe, E.S., Stein, H., Banks, P.M., Chan, J.K.C., Cleary, M.L., et al. (1994) A Revised European-American Classification of Lymphoid Neoplasms: A Proposal from the International Lymphoma Study Group. Blood, 84, 1361-1392. https://doi.org/10.1182/blood.V84.5.1361.bloodjournal8451361
[6]
Moreau, E.J., Matutes, E., A’Hern, R.P., Morilla, A.M., Morilla, R.M., OwusuAnkomah, K.A., et al. (1997) Improvement of the Chronic Lymphocytic Leukemia Scoring System with the Monoclonal Antibody SN8 (CD79b). American Journal of Clinical Pathology, 108, 378-382. https://doi.org/10.1093/AJCP/108.4.378
[7]
Ronot, X., Grunwald, D., Mayol, J.F. and Boutonnat, J. (2006) La cytométrie en flux. éditions Tec & Doc, Paris, 457 p.
[8]
Swerdlow, H., et al. (2008) WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues.
[9]
Merle-Béral, H. and Le Garff-Tavernier, M. (2008) Immunophenotyping of Malignant Hematopathies by Flow Cytometry. EMC—Hématologie, 3, 1-12. https://doi.org/10.1016/S1155-1984(08)47155-8
[10]
Garff-Tavernier, M.L., Costopoulos, M., et al. (2013) Place de la cytométrie en flux dans le diagnostic et le suivi des syndromes lymphoprolifératifs B. Revue Francophone des Laboratoires, 2013, 37-48. https://doi.org/10.1016/S1773-035X(13)72031-8
[11]
Garff-Tavernier, M.L., Costopoulos, M. and Merle-Béral, H. (2013) The Role of Flow Cytometry in the Diagnosis and Monitoring of B-Cell Lymphoproliferative Syndromes. Revue Francophone des Laboratoires, 43, 37-48. https://doi.org/10.1016/S1773-035X(13)72031-8
[12]
Hallek, M., et al. (2008) Guidelines for the Diagnosis and Treatment of Chronic Lymphocytic Leukemia: A Report from the International Workshop on Chronic Lymphocytic Leukemia Updating the National Cancer Institute—Working Group 1996 Guidelines. Blood, 111, 5446-5456. https://doi.org/10.1182/blood-2007-06-093906
[13]
Asplund, S.L., McKenna, R.W., Doolittle, J.E. and Kroft, S.H. (2005) CD5-Positive B-Cell Neoplasms of Indeterminate Immunophenotype: A Clinicopathologic Analysis of 26 Cases. Applied Immunohistochemistry & Molecular Morphology, 13, 311-317. https://doi.org/10.1097/01.pai.0000137363.36091.7e
[14]
Baseggio, L. and Felman, P. (2013) Diagnostic Strategies for Atypical Lymphocytoses. Revue Francophone des Laboratoires, 43, 93-102. https://doi.org/10.1016/S1773-035X(13)72036-7
[15]
Criel, A. et al. (1997) Further Characterization of Morphologically Defined Typical and Atypical CLL: A Clinical, Immunophenotypic, Cytogenetic and Prognostic Study on 390 Cases. British Journal of Haematology, 97, 383-391. https://doi.org/10.1046/j.1365-2141.1997.402686.x
[16]
Kampalath, B., Barcos, M.P. and Stewart, C. (2003) Phenotypic Heterogeneity of B Cells in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. American Journal of Clinical Pathology, 119, 824-832. https://doi.org/10.1309/4AGUT3LKEURD7T7K
[17]
Le Gouill, S. (2010) Le lymphome à cellules du manteau: Du diagnostic aux perspectives thérapeutiques. La Revue de Médecine Interne, 31, 615-620. https://doi.org/10.1016/j.revmed.2009.05.016
[18]
Matutes, E., et al. (1993) The Immunophenotype of Hairy Cell Leukemia (HCL). Proposal for a Scoring System to Distinguish HCL from B-Cell Disorders with Hairy or Villous Lymphocytes. Leukemia & Lymphoma, 14, 57-61.
[19]
Nabhan, C. and Rosen, S.T. (2014) Chronic Lymphocytic Leukemia: A Clinical Review. JAMA, 312, 2265-2276. https://doi.org/10.1001/jama.2014.14553
[20]
van der Velden, V.H.J., et al. (2014) B-Cell Prolymphocytic Leukemia: A Specific subgroup of Mantle Cell Lymphoma. Blood, 124, 412-419. https://doi.org/10.1182/blood-2013-10-533869
