Image Description
Majority of CLL cases show unbalanced cytogenetic abnormalities which can be assessed by FISH. They include: losses of 13q14.3 (most common abnormality; seen in 50% of cases; linked to improved survival), 13q34, 17p13.1 (5% to 10% of CLL cases; associated with disease progression and is an adverse prognostic indicator; linked to mutation of TP53 gene) , 11q22.3, and trisomy 12. In a subset of CLL cases, somatic mutations of IGH@ variable region (V) genes have been identified. They are linked to the expression of ZAP-70 - an independent prognostic marker. The image shows higher magnification of a proliferation center from a lymph node involved with CLL/SLL.
About the Disease
B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) are the most common mature B-cell neoplasms and considered to be different manifestations of the same disease. CLL: It is the most common mature B-cell leukemia in the Western hemisphere and makes up 30% of all leukemias. It mainly affects middle-aged and elderly patients with a male predominance. The neoplastic cells are predominantly in blood and bone marrow. CLL is asymptomatic in most patients and often detected incidentally on complete blood counts. The diagnosis requires absolute mature lymphocytosis of ≥ 5.0 x 109/L sustained for at least 3 months. Immunophenotype: Multicolor flow cytometry shows the following results in a typical case: mature B-cell phenotype with weak monotypic surface immunoglobulin, CD5 coexpression, weak CD20, weak CD22, CD23, CD19, weak CD11c; negative for CD10, FMC7, and CD79b. SLL: In contrast to CLL, SLL is much less common, making up only about 4% of non-Hodgkin lymphomas. The distribution of the neoplastic cells in SLL is mainly extramedullary with very few leukemic cells in blood. The patients are often asymptomatic but may present with lymphadenopathy and splenomegaly.