Small lymphocytic lymphoma/chronic lymphocytic leukaemia

Question 1

What are the pathological features of SLL/CLL

Answer 1

Effacement of nodes by small round lymphocytes

Clumped chromatin

Inconspicuous nucleoli

Scanty cytoplasm

Low mitotic rate

Proliferative centres - contain prolymphocytes and paraimmunoblasts, increased Ki67 staining

Question 2

What is the immunoprofile of SLL/CLL

Answer 2

CD5 +ve (diffuse, strongly)

CD20, CD19, +ve

CD23+ve

CD79a -ve or dim +ve

Cyclin D1 -ve

CD10, BCL-6 -ve

Question 3

How is SLL/CLL distributed?

Answer 3

Usually diffuse

Sometimes interfollicular - interfollicular variant SLL/CLL

Question 4

What confers adverse prognosis in SLL/CLL

Answer 4

Large cell transformation - Richter syndrome

Occasionally, Reed-sternberg cells are seen in SLL/CLL

Question 5

Which marker is useful to distinguish SLL from MCL?

Answer 5

Cyclin D1

CD23 (SLL +ve, MCL -ve)

Question 6

What other organs are ususally involved in SLL?

Answer 6

Bone marrow

Splenic white and red pulp

Liver portal tracts

Question 7

What are the clinical features of SLL?

Answer 7

Non-specific fatigue, weight loss, anorexia

Lymphadenopathy

Hepatosplenomegaly

Hypogammaglobulinaemia (leads to increased bacterial infections)

Haemolytic anaemia/thrombocytopaenia