Figure 13.4 Sezary cells. Note the folded or convoluted nuclear membrane that may appear cerebriform.

and individuals who progress to this phase have decreased survival rates. Sezary cells shown CD2, CD3, CD4, and CD5 markers10 (Fig. 13.4).

Prolymphocytic Leukemia

Prolymphocytic leukemia (PLL) is a variant of chronic lymphocytic leukemia. A rare disorder, this peripheral smear of individuals with PLL shows a majority of circulating prolymphocytes. These cells of lymphoid origin have more abundant cytoplasm than mature lymphocytes, and their nuclear chromatin appears more mature and coarse. This leukemia has a poor prognosis and, in contrast to CLL patients, these patients have more severe symptoms such as splenic enlargement, liver involvement, and escalating white counts. Individuals with PLL will show strong CD20 markers and SIg activity and will also be positive for CD19 and CD20.

Hodgkin's and Non-Hodgkin's Lymphoma (Briefly)

Hodgkin's lymphoma represents a significant lympho-proliferative disorder with a bimodal incidence. It is one of the most common lymphomas in young males between the ages of 14 and 40, but it also may be seen in individuals older than 50 years. Most patients complain of a single lymph node in the cervical region that is firm to the touch and usually does not disappear. Symptoms of hypermetabolism such as low-grade fever and weight loss may be present. Individuals who have had previous exposure to Epstein-Barr virus or who have been exposed to environmental hazards may be more vulnerable to Hodgkin's lymphoma. Diagnosis is made based upon the cellular features seen in lymph node biopsy, which may feature a Reed-Sternberg cell, a large multinucleated cell resembling an "owl's eye." Other histo-

logical classifications of lymphoma include lymphocyte predominant (5%), nodular sclerosing (60%), mixed cellularity (20%), and lymphocyte depleted (5%). The disease may spread across the lymphatic system and may involve the liver, spleen, and bone marrow. Prognosis is good, however, with a high cure rate.

Non-Hodgkin's lymphoma is three times more common than Hodgkin's lymphoma and may present as painless cervical lymph node involvement. The lymph nodes may be enlarged, and the disease may spread to the gastrointestinal and respiratory systems, skin, liver, and spleen. The range of spread may be more sporadic than that of Hodgkin's lymphoma, and lymphoma cells may be seen in the peripheral blood. Any history of congenital or acquired immunological disorder may be a predisposing factor in the development of non-Hodgkin's lymphoma. The diagnostic scheme is divided into low grade, intermediate grade, or high grade based on the different histological types of lymphocytic cells. Radiation and chemotherapy may be successful in obtaining remission, but relapses for non-Hodgkin's lymphoma are frequent.11

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