title: Morphologic identification of atypical chronic lymphocytic leukemia by digital microscopy.
abstract: BACKGROUND
  Atypical chronic lymphocytic leukemia (aCLL) is a morphologic variant found in approximately 25% of patients with chronic lymphocytic leukemia (CLL). Although aCLL has a more aggressive course compared to typical CLL (tCLL), it is not usually reported. This retrospective study used digital microscopy to morphologically classify CLL patients as aCLL or tCLL, and determined the prevalence of prognostic markers in each group.
  
  
  METHODS
  CellaVision AB (Lund, Sweden) was used to evaluate lymphocyte morphology on archived blood films of 97 CLL patients, and results of their prognostic marker analysis at diagnosis were obtained. The unpaired t-test, Chi-square, or Fisher's Exact test were used for statistical analysis.
  
  
  RESULTS
  27% of CLL cases were morphologically classified as aCLL. The aCLL group had a higher prevalence of trisomy 12, unmutated IgVH, and CD38 expression (markers associated with poor prognosis), and a lower prevalence of 13q14 deletions compared to tCLL; this was statistically significant.
  
  
  CONCLUSIONS
  Using digital imaging to identify aCLL is feasible, economical, and may provide clinically relevant prognostic information at diagnosis and during periodic monitoring. Further study of a larger number of patients is needed to assess the clinical utility of reporting aCLL morphology.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA; Rutgers-School of Health Related Professions, Newark, NJ, USA.
authors.forename: S
authors.initials: S
authors.lastname: Marionneaux
authors.forename: P
authors.initials: P
authors.lastname: Maslak
authors.forename: E M
authors.initials: EM
authors.lastname: Keohane
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000235:genetics; D001402:B-Lymphocytes / Q000473:pathology*; D002872:Chromosome Deletion; D002881:Chromosomes, Human, Pair 12; D002882:Chromosomes, Human, Pair 13; D005260:Female; D015870:Gene Expression; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology*; D008297:Male; D008853:Microscopy / Q000379:methods; D014314:Trisomy
chemical_list: D007143:Immunoglobulin Heavy Chains; D051997:ADP-ribosyl Cyclase 1
keywords: Atypical chronic lymphocytic leukemia; chronic lymphocytic leukemia (CLL); digital imaging; morphology