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Blood Res 2022; 57(4):
Published online December 31, 2022
https://doi.org/10.5045/br.2022.2022120
© The Korean Society of Hematology
Various inclusions in chronic lymphocytic leukemia/small lymphocytic lymphoma
Correspondence to : Verónica Roldán Galiacho, M.D., Haematology Department, Hospital Universitario Cruces, Plaza Cruces s/n., Barakaldo, Bizkaia 48903, Spain, E-mail: veronica.roldangaliacho@osakidetza.eus
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
(A) Globular inclusions in peripheral blood lymphocytes in a 67-year-old woman with 5-year history of CLL managed with a “watch and wait” approach. Other findings included increased lymphocyte count of 270×109/L, hemoglobin of 110 g/L, and platelets of 78×109/L. Serum lactate dehydrogenase level was normal. Positron emission tomography/computed tomography revealed multiple adenopathies with low SUV and no evidence of transformation. (B) Multiple crystalline inclusions in peripheral blood lymphocytes in a 60-year-old asymptomatic woman with axillary lymphadenopathies. Laboratory evaluations revealed the following: hemoglobin of 132 g/L, platelets of 212×109/L, and lymphocytes of 3.7×109/L. B-cells revealed clonal CLL phenotype on flow cytometry. Lymph node biopsy revealed lymphoid infiltrate with low Ki67 and positivity for CD20, CD23, and CD5. A diagnosis of SLL was established. (C) Azurophilic needle-shaped inclusions (“Auer rod-like”) in a 45-year-old asymptomatic man with the following laboratory parameters: hemoglobin of 163 g/L, platelets of 287×109/L, and lymphocytes of 10.08×109/L. These atypical lymphocytes had CLL phenotype (positive for CD19, CD20, CD5, CD23, CD200, and CD43; negative for CD10 and kappa and lambda surface chains) on flow cytometry (all images, May–Grünwald Giemsa staining, ×100). The presence of inclusions is an uncommon finding in B-cell lymphoproliferative disorders; however, they can aid in arriving at the diagnosis. They are more frequently described in CLL with an approximate incidence of 5%. On light microscopy, the inclusions may have different forms and density. They may appear at diagnosis or during disease evolution.
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Image of Hematology
Blood Res 2022; 57(4): 247-247
Published online December 31, 2022 https://doi.org/10.5045/br.2022.2022120
Copyright © The Korean Society of Hematology.
Various inclusions in chronic lymphocytic leukemia/small lymphocytic lymphoma
Verónica Roldán Galiacho1, Ana Lobo Olmedo1, Javier Arzuaga-Mendez1, Juan Carlos García-Ruiz1,2
1Hematology Department, Hospital Universitario Cruces, 2BioCruces Health Research Institute, Barakaldo, Spain
Correspondence to:Verónica Roldán Galiacho, M.D., Haematology Department, Hospital Universitario Cruces, Plaza Cruces s/n., Barakaldo, Bizkaia 48903, Spain, E-mail: veronica.roldangaliacho@osakidetza.eus
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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(A) Globular inclusions in peripheral blood lymphocytes in a 67-year-old woman with 5-year history of CLL managed with a “watch and wait” approach. Other findings included increased lymphocyte count of 270×109/L, hemoglobin of 110 g/L, and platelets of 78×109/L. Serum lactate dehydrogenase level was normal. Positron emission tomography/computed tomography revealed multiple adenopathies with low SUV and no evidence of transformation. (B) Multiple crystalline inclusions in peripheral blood lymphocytes in a 60-year-old asymptomatic woman with axillary lymphadenopathies. Laboratory evaluations revealed the following: hemoglobin of 132 g/L, platelets of 212×109/L, and lymphocytes of 3.7×109/L. B-cells revealed clonal CLL phenotype on flow cytometry. Lymph node biopsy revealed lymphoid infiltrate with low Ki67 and positivity for CD20, CD23, and CD5. A diagnosis of SLL was established. (C) Azurophilic needle-shaped inclusions (“Auer rod-like”) in a 45-year-old asymptomatic man with the following laboratory parameters: hemoglobin of 163 g/L, platelets of 287×109/L, and lymphocytes of 10.08×109/L. These atypical lymphocytes had CLL phenotype (positive for CD19, CD20, CD5, CD23, CD200, and CD43; negative for CD10 and kappa and lambda surface chains) on flow cytometry (all images, May–Grünwald Giemsa staining, ×100). The presence of inclusions is an uncommon finding in B-cell lymphoproliferative disorders; however, they can aid in arriving at the diagnosis. They are more frequently described in CLL with an approximate incidence of 5%. On light microscopy, the inclusions may have different forms and density. They may appear at diagnosis or during disease evolution.
