76 yrs woman with clinical diagnosis of B CLL underwent threpine biopsy.
HISTO/IH: Interstitial and slightly nodular CD20+ CD79a+ CD5+ CD23+ CD43+ IgM+ IgD+ infiltration of small lymphos; More peripheral infiltration of "plasmacytoid" cells with Ig (Dutcher) inclussions CD20- CD79a- Pax-5- CD138+ IgM+ > IgD+.
HISTORY/CLINICS: 1. Lymphocytosis in peripheral blood 94.8% and bone marrow 72%; Hb in PB 93.4; 2. PLasmocytes in BM 3.5%; 3. Hepatomegaly (sono). IG studies not done up to date (will be cont'd).
INTERESTING FEATURES: 1. Ig lambda restriction on small B cells; Ig kappa restriction on the "plasmoid" cells. 2. CyclinD1+ 100% in"plasmoid" population. 3. FLOW: CD5+ CD23+ FMC7+ CLL population with Ig kappa restriction (12/1);
CLL with plasmoid features, biclone