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CD23 negative chronic lymphocytic leukemia of the tonsil: report of a case
Insights
This case study describes atypical chronic lymphocytic leukemia (CLL) presenting as a tonsillar mass. The diagnosis was confirmed despite unusual flow cytometry and cytogenetic findings, highlighting diagnostic challenges in rare CLL presentations.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Chronic lymphocytic leukemia (CLL) typically presents with specific immunophenotypic markers.
- Atypical presentations of CLL can pose diagnostic challenges.
Observation:
- An elderly male presented with a tonsillar mass, initially suspected as lymphoma.
- Histology showed diffuse submucosal infiltration by small lymphocytes.
- Flow cytometry revealed a monoclonal B-cell population expressing CD5, CD19, and lambda light chain, but lacking CD10, CD23, and FMC7.
Findings:
- Molecular cytogenetics identified a t(11;14)(q13;q32) chromosomal translocation.
- Further molecular studies ruled out bcl-1 gene rearrangement.
- A diagnosis of CD23-negative CLL was established.
Implications:
- This case underscores the importance of considering atypical CLL presentations, even with unusual immunophenotypes.
- The t(11;14) translocation in the absence of bcl-1 rearrangement presents a diagnostic dilemma.
- Accurate diagnosis requires comprehensive analysis including flow cytometry and molecular studies.
Abstract:
We present the case of atypical chronic lymphocytic leukemia presenting as a tonsillar mass in an elderly man. Histological examination of the tumor revealed diffuse submucosal infiltration by small lymphocytes. On flow cytometry, a monoclonal B lymphocytic population expressing CD5, CD19, lambda light chain, but not expressing CD10, CD23, or FMC7 activities, was observed. A diagnostic conundrum occurred with the demonstration on molecular cytogenetic analysis of the chromosomal translocation abnormality, t(11;14)(q13;q32). The diagnosis of CD23 negative chronic lymphocytic leukemia was made after further molecular studies failed to detect the bcl-1 gene rearrangement.
