Differentials
Leukemic phase of lymphoma
SIGNS / SYMPTOMS
No differentiating features.
INVESTIGATIONS
Mantle cell lymphoma (MCL), follicular lymphoma, lymphoplasmacytic lymphoma (Waldenström macroglobulinemia), and hairy cell leukemia (HCL) cells may mimic CLL morphologically.
HCL cells have fine (hair-like) projections on the cell surface which can distinguish them from CLL cells morphologically.
Immunophenotyping (i.e., flow cytometry) and genetic testing are required to establish a diagnosis.
MCL immunophenotype is usually CD23-, cyclin D1+, and CD200-, whereas CLL is CD23+, cyclin D1-, and CD200+.
CD200 positivity may distinguish CLL from MCL.[33]
Fluorescence in situ hybridization for t(11;14) will be positive in the majority of MCL, but negative in CLL.
Hairy cell leukemia (classical) immunophenotype is usually: CD5-, CD10-, CD11c+, CD20+ (bright), CD22+, CD25+, CD103+, CD123+, cyclin D1+, annexin A1+, and CD200+ (bright); BRAF V600E mutation is often present.[49]
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