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A 7 LJ-year-old male with no sign i ficant medical history is referred by h is primary care physician For Further evaluation of generalized lymphadenopathy. Patient reports no preceding weigh t loss. n igh t sweats. or Fever. On physical examination. lymphade-nopathy and splenomegaly are Found. with the spleen edge pal pable 7 em below the left costal margi n. Laboratory workup reveals a total leu kocyte count of 36.500/pl. with the majority of cells of the type shown below. hemoglobin 1 LJ.S g/dl and a plate-let count of 3LJ2 .000/ pl.
What is the most likely diagnosis based on clinical presentation and peripheral blood smear findings?
- Mantle cell lymphoma (MCL)
- Follicular lymphoma (FL)
- Acute myeloid leukemia (AML)
- Small lymphocytic lymphoma (SLL)
- Chronic lymphocytic leukemia (CLL)
Medicine
E. The blood smear shows a major population of small lymphocytes with condensed chromatin and a "smudge cell." The patient's presentation with generalized asymptomatic lymphadenopathy and splenomegaly and increased small mature lymphocytes as depicted in the blood smear is most consistent with the diagnosis of CLL, which is the most common type of leukemia in the Western world. Statistically, CLL would be the most likely diagnosis. SLL is considered a nodal coun-terpart of CLL and is diagnosed when lymphadenopathy is present and the peripheral blood monoclo-nal B lymphocyte count is less than 5,000/ ,LLL. CLL requires the presence of at least 5,000 monoclonal B lymphocytes per JLL. Cases not meeting diagnostic criteria for SLL with less than 5,000 monoclonal B lymphocytes per ,LLL in peripheral blood, with otherwise typical flow cytometry features of CLL, are denoted as clonal B-cell lymphocytosis (Blood. 2008;111(12):5446).
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