Metastatic Merkel cell carcinoma involving the bone marrow with chronic lymphocytic leukemia mimicking Richter transformation

摘要

79-year-old woman presented with new-onset weight loss, bilateral axillary lymphadenopathy (LAD), and a chest wall mass. complete blood count showed a leukocytosis of 87 600/jjlL with 99% lymphocytes. A review of the peripheral blood smear and flow cytometry (data not shown) showed chronic lymphocytic leukemia (CLL).Due to B symptoms, LAD, and a chest wall mass, a Richter transformation (RT) of the CLL was highly suspected. The bone marrow aspirate revealed extensive marrow involvement by CLL. In addition, there were many large cells with oval nuclear contours and open chromatin. These cells were arranged singly or in small cohesive clusters.