Prolymphocytic leukemia: histologic findings in atypical cases

Area of Science:

• Hematology
• Oncology
• Immunology

Background:

• Prolymphocytic leukemia (PLL) is typically characterized by the absence of significant peripheral lymphadenopathy, making this a key diagnostic feature.
• Previous literature consistently reports minimal to no lymph node enlargement in PLL, aiding in its differentiation from other lymphoid malignancies.

Observation:

• This study presents two unique cases of prolymphocytic leukemia exhibiting striking and persistent lymphadenopathy throughout the clinical course.
• These cases contrast sharply with established clinical presentations of PLL described in existing research.

Findings:

• Immunophenotypic analysis of lymph node cells indicated a B-cell type leukemic process in both patients.
• One patient experienced a dramatic, albeit transient, response to L-asparaginase treatment.
• Wright-Giemsa stained touch preparations of lymph node aspirates proved useful for characterizing the prolymphocytic proliferation.

Implications:

• The presence of significant lymphadenopathy in PLL, though rare, should be considered in differential diagnoses.
• These findings expand the clinical spectrum of prolymphocytic leukemia and may necessitate re-evaluation of diagnostic criteria.
• Further research into the specific characteristics and treatment responses of PLL with lymphadenopathy is warranted.