74yrs male with clinical diagnosis CLL.  
HISTORY: 2000 WBC 115 (LYMPH 95%); HB 109g/l; RBC 3.7; PLT 110. Hepatosplenomegaly. Leukeran therapy. 2007 progression of CLL.  
BM: B CLL/SLL with Ig lambda expression/restriction and IgM>IgD expression, 90% of the BM space.  
IH: CD20/CD23 (+/++) 40%, CD5(+/++) 80%, CD43/CyclinD1(-), Ki67+ <5% (++++), CD3(-)(except T), Mum1(+/++) 10%, Ig lambda (+/++)>>>Ig kappa, IgM 80%>> IgD(+)30%. Single CD138+ plasmacytes.  
QUESTION: Plasmoid differentiation and IgM+>>IgD inerpretation.  
 
PLEASE FIND SIMILAR CASE, NAMED "CLL and LIKE: Part 2".  
Thank you.

tzankov 2007-10-03 10:03	for me, a clear cut lymphoplasmocytoid CLL variant; could be accompanied by rised serum IgM and thus mimik immunocytoma or secretory marginal zone lymphoma
ugnius 2007-10-10 09:53	Dear dr.Tzankov, thank you for the comments. I keep in mind your comments and questions and will append the info requested by you. The main problema is that I'm located distantly from clinics and manage the information filled in the aquisition form only.
Went 2007-10-12 10:40	i agree with dr. tzankov. the diagnosis herein is CLL, which frequently is IgD+.
ugnius 2007-10-15 09:07	Please find some clin detailos above. Appologies: I have no data about paraproteins in this case up to date.
anpo 2007-10-20 23:24	This case is a clear-cut CLL (CD5+/CD23+) with some lymphoplasmacytoid differentiation. These cases were considerd as lymphoplasmacytoid immunocytomas in Kiel classification and then moved to CLL-category in REAL classification.
hurwitz 2007-11-12 00:25	The final diagnosis is this case is:   CLL, lymphoplasmacytoid variant.   Thanks to Ugnius for the submission of this case and thanks to everybody who contributed to the discussion.
	» Add comment (Login)