Unique scanning electron microscopic features of hairy cells in hairy-cell leukemia. A review and current status

Past scanning electron microscopy (SEM) reports demonstrated cell surface undulations, ridges, folds, and ruffles to support the monocytic/histiocytic nature of hairy-cell leukemia (HCL) cells. On the other hand, SEM studies illustrating spikes, villi, and microvilli on the cell surfaces favored the lymphocytic nature of hairy cells (HCs). The evidence for the 'hybrid' nature of the HCs has emerged from the demonstration of concurrent display of monocytic (ruffles) and lymphocytic (microvilli) surface features on each cell. Utilizing improved methods of sampling, fixation, and drying, the current status is that all HCs display microvilli and ruffles simultaneously. However, two distinct morphological types of HCs are acknowledged: cells showing ruffled areas next to clumps of microvilli (type A), and cells displaying microvilli interspersed among ruffles (type B). Each of the HCL cases reported in our studies had cells with either type A or type B surface features. Amazingly, these unique SEM features correlate well with the prevalent trend to classify HCs as malignant (villous) B-lymphocytes imitating (ruffled) monocytes in some functional respects.