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Blastic transformation of hairy cell leukemia
Insights
This study reports the first documented case of blastic transformation in hairy cell leukemia, a rare B-cell lymphoproliferative disorder. This transformation presents as a new aggressive malignancy, requiring consideration in differential diagnoses.
Area of Science:
- Hematology
- Oncology
- Cell Biology
Background:
- Hairy cell leukemia (HCL) is a rare, chronic B-cell lymphoproliferative disorder.
- Blastic transformation is an uncommon but aggressive complication of chronic lymphoproliferative disorders.
Observation:
- A patient with typical HCL features developed a blastic lymphoproliferative malignancy post-splenectomy and before other treatments.
- This transformation was characterized by loss of tartrate-resistant acid phosphatase activity and specific cell surface marker expression.
Findings:
- Immunophenotypic analysis revealed expression of CD11c and CD25, and DBA.44 reactivity in the blastic phase.
- Histology, cytochemistry, and ultrastructural analysis confirmed the blastic nature of the transformation.
Implications:
- This case represents the first reported instance of blastic transformation in hairy cell leukemia.
- Clinicians should consider blastic transformation of HCL in the differential diagnosis of chronic lymphoproliferative disorders.
Objective:
To report blastic transformation of hairy cell leukemia, an uncommon lymphoproliferative disorder of B-cell lineage.
Design:
Routine histology, cytochemistry, and ultrastructural analysis were used to study this case. Immunoperoxidase studies for leukocyte common antigen (CD45), pan B-cell marker L26 (CD20), and hairy cell leukemia marker DBA.44 were performed. In addition, cell surface marker analysis for CD19, CD20, CD5, CD25, CD11c, and kappa and lambda light chains by flow cytometry was performed.
Results:
The patient presented with typical clinical, morphologic, cytochemical, immunophenotypic, and ultrastructural features of hairy cell leukemia. Following splenectomy and prior to institution of any other therapy, he developed a blastic lymphoproliferative malignancy with loss of tartrate-resistant acid phosphatase activity, expression of cell surface markers CD11c and CD25, and immunoreactivity for DBA.44.
Conclusion:
We believe this to be the first report of such a transformation and recommend that the differential diagnosis of blastic transformation of chronic lymphoproliferative disorders include such a possibility.
