Variant hairy cell leukemia following papillary urothelial neoplasm of bladder.
A 65 years old man was admitted with multiple lymphadenopathy, weight loss, night sweats and fatigue for 2 months. He had been treated for bladder cancer 2 years ago. Leukocyte count was 37.9 x10(9)/l. Peripheral blood smear had 91% lymphocytes. Lymphocytes had large nuclei with prominent nucleoli, heterogeneous appearance, and large cytoplasm with hairy projections. Flow cytometric immunophenotyping revealed CD20, CD22, CD24, CD45 and HLA-DR positivity. Atypical lymphocytes were stained with tartrate resistant acid phosphatase. Increased metabolic activity was detected in multiple lymph nodes, bone marrow and extremely enlarged spleen with positron emission tomography-computed tomography. Excisional biopsy of the left axillary lymph node revealed infiltration with diffuse B-cell leukemia/lymphoma. Immunohistochemistry showed CD20 positive atypical cells with weak expression of CD11c. The patient was diagnosed as a case of variant hairy cell leukemia and cladribine was administered. A probable second primary malignancy should be kept in mind in cases with a defined malignancy in the presence of unusual symptoms.
Department of Haematology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Cengiz
C
Beyan
Department of Haematology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
Kürsat
K
Kaptan
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000473:pathology; D017338:Cladribine / Q000627:therapeutic use; D005434:Flow Cytometry; D014644:Genetic Variation / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007943:Leukemia, Hairy Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics / Q000276:immunology; D008297:Male; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000473:pathology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D017338:Cladribine