[Asymptomatic 32 year old female smoker with persistent polyclonal lymphocytosis].
A 32 year old female smoker (20 pack years) presented with an asymptomatic lymphocytosis of 13,000/nl and splenomegaly. The patient's blood smear showed an absolute lymphocytosis with 65% atypical lymphocytes. A total of 1% of the lymphocytes were bilobulated. Bone marrow histology and immunphenotyping of blood and bone marrow excluded leukemia and non-Hodgkin's lymphoma. IgH-CDR-3 PCR analysis revealed a polyclonal pattern. In summary, a persistent polyclonal B-cell-lymphocytosis (PPBL) was diagnosed. The exact etiology of PPBL is still unclear, however, it is associated with a polyclonal raise in the lymphocyte count of CD27+IgD+-memory-B-lymphocytes due to a defect in apoptosis signaling and leukocyte homing to secondary lymphoid tissues. An association with cigarette smoking is obvious since all patients are smokers. From all published cases, only two developed a malignancy with an uncertain association with PPBL. We have been monitoring our patient for 6.5 years without any evidence of the development of a lymphoma.
Chapuy
B
B
Abteilung für Hämatologie und Onkologie, Universitätsklinikum Göttingen, Göttingen, Deutschland. bchapuy@gwdg.de
Wulf
G
G
Tessen
H W
HW
Griesinger
F
F
Trümper
L
L
Schroers
R
R
D000328:Adult; D001402:B-Lymphocytes / Q000473:pathology; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008218:Lymphocytosis / Q000175:diagnosis* / Q000628:therapy; D016133:Polymerase Chain Reaction; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D013163:Splenomegaly / Q000209:etiology*