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Hairy cell leukemia involving an inguinal hernial sac
M J Melaragno1, K S Theil, W L Marsh
1Department of Pathology, Ohio State University College of Medicine, Columbus.
Insights
Hairy cell leukemia, a rare cancer, can infiltrate unexpected soft tissues like a hernia sac. This case highlights the unusual spread of hairy cells in a patient with leukemia.
Area of Science:
- Hematology
- Oncology
- Surgical Pathology
Background:
- Hairy cell leukemia (HCL) is a rare B-cell malignancy.
- Inguinal hernias are common surgical conditions.
- Extranodal involvement in HCL is known but typically involves spleen, liver, and bone marrow.
Observation:
- A 37-year-old male patient with known hairy cell leukemia was incidentally found to have a right inguinal hernia.
- Microscopic examination of the surgically resected herniorrhaphy specimen revealed extensive transmural infiltration by leukemic cells.
- The infiltrating cells exhibited characteristic features of hairy cells, including surface cytoplasmic projections and a B-cell immunophenotype.
Findings:
- This represents the first reported case of hairy cell leukemia involving a hernial sac.
- The findings demonstrate the potential for hairy cells to infiltrate unusual soft-tissue sites.
- The leukemic cells were identified within the connective tissues of the hernia sac.
Implications:
- This case expands the known spectrum of extranodal involvement in hairy cell leukemia.
- It underscores the importance of thorough histopathological examination of all surgical specimens, even in seemingly incidental findings.
- Further research may explore the mechanisms driving such unusual soft-tissue infiltration in HCL.
Abstract:
A 37-year-old man with hairy cell leukemia was found incidentally to have a right inguinal hernia. Microscopic examination of the resected herniorrhaphy specimen disclosed dense transmural infiltration by hairy cells. Electron-microscopic and immunoperoxidase studies confirmed the presence of surface cytoplasmic projections and B cell phenotype, respectively, of the infiltrating cells. This case is, to our knowledge, the first reported instance of hairy cell leukemia involving a hernial sac and demonstrates the capacity of hairy cells to infiltrate unexpected soft-tissue sites.
