Subhawong A P, Subhawong T K, Ali S Z
Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Acta Cytol. 2012;56(4):463-6. doi: 10.1159/000335731. Epub 2012 Jul 25.
Hairy cell leukemia (HCL) usually presents with peripheral cytopenias, diffuse marrow infiltration, and splenomegaly. This chronic lymphoproliferative disorder is not typically associated with lymphadenopathy or mass lesions. We report a case of HCL first treated by splenectomy, followed by several years of interferon therapy. Twenty-five years later, the patient presented with weight loss, fatigue, and a large PET-avid mass surrounding the head of the pancreas. Fine-needle aspiration was pursued to investigate the unusual and infiltrative appearance of the lesion, which was suggestive of another primary malignancy. Cytology smears showed discohesive lymphoid cells with round nuclei and delicate cytoplasmic projections. Flow cytometry confirmed the presence of a clonal B-cell population with bright expression of CD20 as well as CD25 and CD103, diagnostic of HCL. This is the first report of HCL presenting as a peripancreatic mass. The importance of correlation with radiology and clinical history is emphasized when evaluating such lesions.
毛细胞白血病（HCL）通常表现为外周血细胞减少、弥漫性骨髓浸润和脾肿大。这种慢性淋巴细胞增殖性疾病通常与淋巴结病或肿块病变无关。我们报告一例HCL患者，最初接受脾切除术治疗，随后接受了数年的干扰素治疗。25年后，该患者出现体重减轻、疲劳，以及围绕胰头的一个FDG摄取阳性的大肿块。为了研究该病变不寻常的浸润性表现，进行了细针穿刺活检，提示可能为另一种原发性恶性肿瘤。细胞学涂片显示散在的淋巴细胞，细胞核圆形，细胞质有纤细的突起。流式细胞术证实存在克隆性B细胞群体，CD20、CD25和CD103呈明亮表达，诊断为HCL。这是HCL表现为胰周肿块的首例报告。在评估此类病变时，强调了与放射学和临床病史相关联的重要性。
