Digital imaging of peripheral blood identifies atypical chronic lymphocytic leukemia

摘要

A 77-year-old woman presented with cervical adenopathy. A complete blood count was performed: white blood cells (WBCs), 13.8 X 109/L; absolute lymphocytes, 11.9 X 109/L; hemoglobin, 12.4 g/dL; and platelets, 199 X 109/L. Immunophenotyping of peripheral blood confirmed a diagnosis of chronic lymphocytic leukemia (CLL). Lymphocytes were CD5+, CD19+, CD23+, CD79B+, FMC7~, CD38+, and ZAP70+. Cytogenetics/molecular analysis revealed trisomy 12 and unmutated immunoglobulin heavy chain variable region (IgVH). Positron emission tomography computed tomography showed splenomegaly and widespread adenopathy. WBC differential by digital microscopy (Cellavision) revealed 9% neutrophils, 3% eosinophils, 2% monocytes, 60% lymphocytes, and 26% large abnormal lymphoid cells with clefted nuclei, moderately clumped chromatin, and pale blue cytoplasm. These findings were consistent with French-American-British atypical CLL (aCLL), mixed cell type. Although the possibility of Richter's transformation could not be ruled out, clinical, laboratory, and radiologic findings did not support this diagnosis (data not shown).