Latest results shown my Hemoglobin has dropped to 9.6 despite supplementing with iron & B12. ALC has peaked at 110 too. Having sore throat now. Breathlessness & dizziness have increased. Don't think I have any enlarged nodes. Seeing Dr tomorrow. Most likely needing treatment soon.
Need help to understand the following statement from "Manual differential/slide review":
WBC morphology: Abnornal
Significant Abnormalities: Present
Majority of lymphoid cells are intermediate in size with an open chromatin pattern, <10% with visible nucleoli and more abundant cytoplasm. Please see path review.
Seok
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Seok
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I presume this is the comment 'Majority of lymphoid cells are intermediate in size with an open chromatin pattern, <10% with visible nucleoli and more abundant cytoplasm.'
This comment informs the requesting doctor that the majority of the lymphs are not prolymphs which is an important distinction to make.
Open chromatin refers to the nucleus of the lymphoid cell - CLL lymphs are dense chromatin and prolymphs have open chromatin. Everyone has a few prolymphs.
Abundant cytoplasm refers to the amount of cytoplasm around the nucleus of the cell - it's very little in most CLL lymphs and more abundant in prolymphs.
There is another type of lymphcytic leukaemia called LGL or Large Granular Lymphocytic leukaemia and the name describes it exactly. The lymphs are large, fairly open chromatin with red granules in the cytoplasm. Also important to know that it's not this type of lymph.
I'm sorry, looking again at your post you are right and I misread it - that the minority were open chromatin, which was wrong. The notes about the morphology are still correct though and 'typical' CLL cells do usually have more dense chromatin.
Morphology can only say that that they look like typical CLL cells, which in itself can be variable. Cell morphology and it's interpretation is much more of an art than a science and cells from various lymphoid malignancies can look very similar especially when they have the same lineage eg B cells.
The differences between the cell types can be very subtle, with even experts disagreeing and getting it wrong, which is why morphology alone would not be used these days to establish a diagnosis. This is very true of CLL, SLL, MCL and is the reason why the CD system and antibodies are used to define them more accurately. I'm sorry that I didn't make that point in my comment. Even then some cells have unusual combinations of CD expression that makes a definite diagnosis difficult!
Apologies again, I hope I've helped to make things a bit clearer. Please let us know what your diagnosis is when you know.
"Bone marrow with cellularity of about 70%. There is a nodular and interstitial infiltrate of small lymphocytes with mildly enlarged and irregular nuclei. A few medium sized cells with more distinct nucleoli are noted. Otherwise, there are no definite proliferation centres or confluent large lymphoid cells Megakaryopoiesis, erythropoiesis and granulopoiesis are within normal limits.
Immunohistochemistry:
-The small lymphocytes are B cells and they are positive for CD20, CD5 and BCL2. They are negative for CD10, CD23, cyclinD1 and SOX11.
- Ki67 proliferation index is low in the small B cell population and does not exceed 10%.
- A few of the nodular lymphoid aggregates are associated with CD21-positive follicular dendritic meshworks.
-CD3 stains reactive T cells
-Reticulin is mildly increased (2/4)
DIAGNOSIS
Bone marrow, biopsy: Small B cell lymphoma, CD5-positive.
Comment: Please correlate with flow cytometry, bone marrow aspirate and cytogenetics. The differential diagnosis includes atypical CLL and mantle cell lymphoma. The latter is less likely in view of the lack of expression for cyclinD1 and SOX11."
Am I still atypical CLL, Jackie? Wonder if there're any difference in treatment approach?
nuc ish (ATM, TP53)x2[200],(D12Z3x2,D13S319x1,LAMP1x2)[146/200]/(D12Z3x2,D13S319x0,LAMP1x2)20/200]
Interpretation:
73% of 200 nuclei showed loss of one copy of D13S319 gene at 13q14.3. Homozygous deletion or loss of both copies of D13S319 was seen in 10% of 200 nuclei scored.
Normal FISH patterns were observed for ATM, CEP12 and TP53. This test is positive for B-CLL FISH panel. Kindly correlate FISH results with other clinical findings.
Results:
200 interphase nuclei from peripheral blood were evaluated for LSI ATM (11q22.3), CEP12 (chromosome 12 centromere), D13S319 (14q14.3) and TP53 (17p13.1) using the B-CLL panel for FISH.
Am I correct to conclude that I do not hv ATM, Trisomy 12 & TP53 defects?
Need help to explain Karyotype, is it typical? Or maybe I'm being too ambitious to try to understand... 😖 (Brain fog)!
It looks like CLL from the immunohistochemistry and cytogenetics. The atypical part refers to the morphology I think - small lymphocytes with mildly enlarged and irregular nuclei which reflects your blood report.
MCL expresses CD 23 and cyclinD1 and your cells are negative for both.
Regarding the cytogenetics - 13q14.3 is seen in about 50% of CLL patients and is generally regarded as conferring a good prognosis. MCL usually shows 11:14 which your cells do not have
Here is a link to a useful website that should clarify things for you:
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Trying to understand CLL
WBC doubles
Ivermectin and wbc
WBC 18 to 61.56- how about WBC 22 to 3.6
Increase in WBC
