V

Figure 13.3 Hairy cell leukemia, showing hair-like projections in large mononuclear cells.

data in an attempt to project disease prognosis and risk factors.

Hairy Cell Leukemia

Hairy cell leukemia (HCL) is a rare B-cell malignancy in which the key morphological entity is a fragile appearing mononuclear cell with hair-like or ruffled projections of the cytoplasm (Fig. 13.3). The nuclear material in these cells is round or dumbbell shaped with a spongy appearance of the chromatin. Hairy cells represent approximately 50% of cells seen in the peripheral smear. These cells eventually infiltrate the bone marrow and spleen, leading to pancytopenia and thrombocytopenia. Most patients are older, in their fifth decade, with more males than females being affected. Abdominal discomfort is a frequent presenting symptom; more than 80% of patients show massive spleens that misplace the stomach. Bleeding, infections, and anemia develop as malignant cells predominate in the bone marrow and peripheral circulation. Neutrophils and monocytes are greatly reduced. Bone marrow aspirates are usually unsuccessful and lead to a dry tap. Dry taps occurs when the normal bone marrow architecture becomes filled

Table 13.1 O Modified Rai Staging for Chronic Lymphocytic Leukemia

Staging Lymphocytes Lymph Nodes Spleen Platelet Count Survival

0 Increased 12.5 years

1 Increased Enlarged 8.5 years

II Increased Enlarged/some Enlarged 6 years

III Increased Enlarged/some Enlarged 1.5 years

IV Increased Decreased 1.5 years

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