Hairy Cell Leukemia With Splenic Rupture: Hematological Changes and Disappearance of Hairy Morphology After...

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Hairy cell leukemia (HCL) is a rare B-cell malignancy.
• Splenic involvement is common in HCL, often leading to splenomegaly and complications.

Observation:

• A 64-year-old man presented with splenic rupture after a fall, revealing characteristic hairy cells on peripheral smear.
• CT angiography showed splenomegaly with a hematoma and active bleeding, necessitating splenic artery embolization and subsequent splenectomy.
• Pathology confirmed extensive HCL infiltration of the spleen.

Findings:

• Bone marrow biopsy identified HCL cells positive for CD20, CD103, and the BRAF V600E mutation.
• Following splenectomy, the patient's pancytopenia and constitutional symptoms (fatigue, weight loss, night sweats) improved.
• A notable observation was the significant reduction and morphologic smoothing of circulating HCL cells post-splenectomy, a change not previously reported.

Implications:

• Splenectomy may induce molecular or immunological changes affecting HCL cell behavior.
• This finding warrants further investigation into the mechanisms underlying HCL cell alterations post-splenectomy.
• Understanding these changes could offer new insights into HCL treatment and management.