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Oncohematology

Hairy Cell Leukemia: Morphology and Flow Cytometry

A clinical case of hairy cell leukemia: cell morphology in blood and bone marrow, flow cytometry data with co-expression of CD11c, CD103, and CD25.

Anna Belen Anna Belen 1 min
Peripheral blood smear: hairy cell leukemia cell with irregular pale cytoplasm
Peripheral blood smear: hairy cell leukemia cell with irregular pale cytoplasm
Blood smear: HCL cell with characteristic villous cytoplasmic border next to a neutrophil
Blood smear: HCL cell with characteristic villous cytoplasmic border next to a neutrophil
Peripheral blood smear: lymphoid elements with irregular cytoplasmic contours
Peripheral blood smear: lymphoid elements with irregular cytoplasmic contours
Blood smear: typical hairy cell leukemia cell with an oval nucleus
Blood smear: typical hairy cell leukemia cell with an oval nucleus
Peripheral blood smear: single HCL cells with reniform nuclei and cytoplasmic projections
Peripheral blood smear: single HCL cells with reniform nuclei and cytoplasmic projections
Bone marrow smear: cluster of HCL tumor cells with abundant clear cytoplasm
Bone marrow smear: cluster of HCL tumor cells with abundant clear cytoplasm
Bone marrow smear: subtotal infiltration by monomorphic HCL cells
Bone marrow smear: subtotal infiltration by monomorphic HCL cells
Bone marrow smear: diffuse replacement of hematopoiesis by HCL tumor elements
Bone marrow smear: diffuse replacement of hematopoiesis by HCL tumor elements
Flow cytometry: co-expression of CD20, CD25, CD11c, and CD103 on neoplastic B-lymphocytes
Flow cytometry: co-expression of CD20, CD25, CD11c, and CD103 on neoplastic B-lymphocytes

⚠The clinical case was kindly provided by a doctor from 🇮🇱Israel - Anna Belen. ✅A 57-year-old patient with hairy cell leukemia. ✅The CBC is characterized by lymphocytosis combined with monocytopenia and thrombocytopenia. ✅Note the oval, sometimes reniform nuclei with immature chromatin structure, but without nucleoli. Pale, ragged cytoplasm is a recognizable distinguishing feature. ✅Complete replacement of the bone marrow by HCL cells. Photos 6,7,8.❓What other single cells can you identify? ✅Immunophenotyping of bone marrow aspirate shows a characteristic “candle” in the lymphocyte region (red color). The presence of CD11c, CD103, CD25 on B-lymphocytes (CD20) is a diagnostic immunophenotypic feature. (Blue color - T-lymphocytes.) ✅IHC: cells are positive for CD20, PAX5, BCL1, Annexin A1, BRAF.

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