
A 71-year-old man presented with progressively increasing lymphocyte count since the last 12 months. Physical examination was unremarkable. Laboratory studies showed a hemoglobin 13.1 g/dL, leukocytosis of 71.4 K/µL, lymphocyte count of 67.5 K/µL and platelets 172 K/µL. Other tests including whole body PET-CT scan were unremarkable. Peripheral blood smear showed lymphocytosis increased “smudge cells” (A, inset showing smudge cells). Smudge cells were 45% of the total white blood cells. Bone marrow (BM) aspiration and biopsy demonstrated small lymphocytic infiltration with 70% cellularity. Immunohistochemical stains were positive for Cyclin D1 and negative for SOX11. Complex karyotype was detected. FISH studies were positive for