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==Microscopic Pathology== | ==Microscopic Pathology== | ||
* On microscopic histopathological analysis characteristic findings of chronic lymphocytic leukemia include: | * On microscopic histopathological analysis characteristic findings of chronic lymphocytic leukemia include:<ref name="pmid25908509">{{cite journal| author=Hallek M| title=Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment. | journal=Am J Hematol | year= 2015 | volume= 90 | issue= 5 | pages= 446-60 | pmid=25908509 | doi=10.1002/ajh.23979 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25908509 }} </ref><ref name="pmid25461996">{{cite journal| author=Nabhan C, Rosen ST| title=Chronic lymphocytic leukemia: a clinical review. | journal=JAMA | year= 2014 | volume= 312 | issue= 21 | pages= 2265-76 | pmid=25461996 | doi=10.1001/jama.2014.14553 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25461996 }} </ref> | ||
:* Small lymphoid cells | :* Small lymphoid cells | ||
:* Narrow cytoplasmic border | :* Narrow cytoplasmic border | ||
| Line 34: | Line 34: | ||
:* Smudge cells | :* Smudge cells | ||
:* Gumprecht nuclear shadows | :* Gumprecht nuclear shadows | ||
* On Immunohistochemistry characteristic findings of chronic lymphocytic leukemia include: | |||
:* CD20 +ve | |||
:* CD5 +ve | |||
:* CD23 +ve/-ve | |||
:* CD43 +ve | |||
:* Cyclin D1 -ve | |||
:* CD38 -ve/+ve | |||
* Shown below is a series of microscopic images seen in multiple myeloma: | * Shown below is a series of microscopic images seen in multiple myeloma: | ||
<gallery> | |||
Image: | |||
Chronic lymphocytic leukemia - low mag.jpg|Chronic lymphocytic leukemia demonstrated on low magnification<ref name="patho">Chronic Lymphocytic Leukemia. Libre Pathology (2015) http://librepathology.org/wiki/index.php/B_cell_small_lymphocytic_lymphoma/chronic_lymphocytic_leukemia Accessed on October, 12 2015</ref> | |||
Image: | |||
Chronic lymphocytic leukemia - intermed mag.jpg|Chronic lymphocytic leukemia demonstrated on intermediate magnification<ref name="patho">Chronic Lymphocytic Leukemia. Libre Pathology (2015) http://librepathology.org/wiki/index.php/B_cell_small_lymphocytic_lymphoma/chronic_lymphocytic_leukemia Accessed on October, 12 2015</ref> | |||
</gallery> | |||
Revision as of 17:55, 13 October 2015
Pathogenesis
- Chronic lymphocytic leukemia arises from pre-follicular center B cells, that are normally involved in the process of human immunoglobulins production.
- Malignant lymphocytic cells infiltrate hematopoietic sites such as the bone marrow where they interfere with the production of normal blood cells.
- Chronic lymphocytic leukemia may also infiltrate the lymph nodes, spleen, and liver.[1]
- Immune deficiency may occur in chronic lymphocytic leukemia as the majority of cases develop hypogammaglobulinemia.[2]
- Warm autoimmune hemolytic anemia may develop due to the production of IgA and IgG autoantibodies among certain cases of chronic lymphocytic anemia.
- Richter's transformation may occur among 1-5% of chronic lymphocytic leukemia cases.[1]
- Richter's transformation represents the conversion of chronic lymphocytic leukemia into a more aggressive, rapidly growing large B cell lymphoma.
Genetics
- Development of chronic lymphocytic leukemia is the result of multiple genetic mutations that promote leukemic proliferation and apoptotic resistance of mature B cells.[3]
- Structural genomic aberrations involved in the pathogenesis of chronic lymphocytic leukemia include:[1][3]
- Chromosome 13q deletion (most common genetic mutation)
- Chromosome 17p deletion
- Chromosome 11q deletion
- Trisomy 12
- Somatic gene mutations involved in the pathogenesis of chronic lymphocytic leukemia include:[3]
- NOTCH1 gene located on chromosome 9
- MYD88 gene located on chromosome 3
- TP53 gene located on chromosome 7
- ATM gene located on chromosome 11
- SF3B1 gene located on chromosome 2
- FBXW7 gene located on chromosome 4
- CHD2 gene located on chromosome 15
- Production of cytokines, angiogenic factors, and chemokines by the surrounding macrophages and T cells provide important stimuli for the malignant B cells proliferation in chronic lymphocytic leukemia.
Microscopic Pathology
- On microscopic histopathological analysis characteristic findings of chronic lymphocytic leukemia include:[3][2]
- Small lymphoid cells
- Narrow cytoplasmic border
- Dense nucleus
- Lack of nucleoli
- Clumped chromatin aggregates
- Smudge cells
- Gumprecht nuclear shadows
- On Immunohistochemistry characteristic findings of chronic lymphocytic leukemia include:
- CD20 +ve
- CD5 +ve
- CD23 +ve/-ve
- CD43 +ve
- Cyclin D1 -ve
- CD38 -ve/+ve
- Shown below is a series of microscopic images seen in multiple myeloma:
-
![Chronic lymphocytic leukemia demonstrated on low magnification[4]](/images/9/9b/Chronic_lymphocytic_leukemia_-_low_mag.jpg)
Chronic lymphocytic leukemia demonstrated on low magnification[4]
-
![Chronic lymphocytic leukemia demonstrated on intermediate magnification[4]](/images/5/55/Chronic_lymphocytic_leukemia_-_intermed_mag.jpg)
Chronic lymphocytic leukemia demonstrated on intermediate magnification[4]
![Chronic lymphocytic leukemia demonstrated on low magnification[4]](/index.php/File:Chronic_lymphocytic_leukemia_-_low_mag.jpg)
![Chronic lymphocytic leukemia demonstrated on intermediate magnification[4]](/index.php/File:Chronic_lymphocytic_leukemia_-_intermed_mag.jpg)
- ↑ 1.0 1.1 1.2 Chronic Lymphocytic Leukemia (2015) https://en.wikipedia.org/wiki/B-cell_chronic_lymphocytic_leukemia Accessed on October 12, 2015
- ↑ 2.0 2.1 Nabhan C, Rosen ST (2014). "Chronic lymphocytic leukemia: a clinical review". JAMA. 312 (21): 2265–76. doi:10.1001/jama.2014.14553. PMID 25461996.
- ↑ 3.0 3.1 3.2 3.3 Hallek M (2015). "Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment". Am J Hematol. 90 (5): 446–60. doi:10.1002/ajh.23979. PMID 25908509.
- ↑ 4.0 4.1 Chronic Lymphocytic Leukemia. Libre Pathology (2015) http://librepathology.org/wiki/index.php/B_cell_small_lymphocytic_lymphoma/chronic_lymphocytic_leukemia Accessed on October, 12 2015