After a course of treatment, the patient showed refractory pleural effusion, in which
prolymphocyte was found.
His
prolymphocyte count remained less than 5% and there was no evidence of large cell transformation.
B-cell
prolymphocyte leukemia (B-PLL) is a somewhat ill-defined, uncommon entity characterized by marked peripheral lymphocytosis composed of more than 55%
prolymphocytes (large lymphocytes with a prominent central nucleolus).
Bone marrow aspirate smear revealed lymphocyte dominance at the rate of 60% without increased
prolymphocytes.
T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive post-thymic malignancy that is characterized by the proliferation of small- to medium-sized
prolymphocytes.
Nuclear staining with LEF1 is positive in lymphoma cells of SLL; the nuclear staining is stronger in
prolymphocytes and in the transformed large lymphoma cells of Richter syndrome (not shown) (original magnification X500).
In the late 1990s, various groups reported a correlation between clinical outcome and Rai stage with respect to the morphology of CLL lymphocytes, the pattern ofbone marrowinfiltration, lymphocyte doubling time, and the percentage of
prolymphocytes.
More than 55%
prolymphocytes in the blood suggests a diagnosis of B-cell prolymphocytic leukemia (B-PLL) (7).
For CLL samples, the CBC report needs to include both the lymphocyte count and lymphocyte morphologic features, such as the presence of
prolymphocytes, atypical lymphocytes, or smudge cells.
By definition,
prolymphocytes must exceed 55%, and cases with 11-54%
prolymphocytes are designated CLL/PLL [1,2].
A diagnosis of full blown PLL is usually associated with more than 55% circulating
prolymphocytes.
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a neoplasm of small, round, mature B lymphocytes, often admixed with
prolymphocytes and paraimmunoblasts.
