Kim Stanley, Mikami Anna, Stull William
Division of Hematology and Medical Oncology, Department of Medicine, Kern Medical, Bakersfield, CA 93306, USA.
College of Osteopathic Medicine - Northwest, Western University of Health Science, Lebanon, OR 97355, USA.
J Hematol. 2025 Jun;14(3):139-145. doi: 10.14740/jh2045. Epub 2025 Apr 16.
We present the case of a 64-year-old man who suffered a splenic rupture following a fall. A peripheral blood smear showed mononuclear cells with "hairy" cytoplasmic projections. A computed tomography (CT) angiogram revealed splenomegaly with a hematoma and active contrast extravasation. He underwent coil embolization of the splenic artery but subsequently developed worsening abdominal pain and ileus, requiring a splenectomy. Pathological examination of the spleen showed extensive infiltration by hairy cell leukemia (HCL). Bone marrow biopsy revealed hypercellular marrow predominantly infiltrated by HCL cells positive for CD20, CD103, and the V600E mutation. After the splenectomy, pancytopenia gradually improved. The symptoms of the patient, such as fatigue, weight loss, and night sweats, were also resolved. Circulating HCL cells were significantly reduced, and the "hairy" morphology became smoother. To our knowledge, this morphologic change of the hairy cells after splenectomy has not been reported in the past. Its mechanism is not known. We postulate that splenectomy may induce molecular or immunological changes that alter HCL cell behavior, which warrants further research.
我们报告一例64岁男性患者，其在跌倒后发生脾破裂。外周血涂片显示单核细胞有“毛发样”细胞质突起。计算机断层扫描（CT）血管造影显示脾肿大伴血肿及造影剂外渗。他接受了脾动脉线圈栓塞术，但随后出现腹痛加剧和肠梗阻，需要进行脾切除术。脾脏病理检查显示毛细胞白血病（HCL）广泛浸润。骨髓活检显示骨髓细胞增多，主要被CD20、CD103和V600E突变阳性的HCL细胞浸润。脾切除术后，全血细胞减少逐渐改善。患者的疲劳、体重减轻和盗汗等症状也得到缓解。循环中的HCL细胞显著减少，“毛发样”形态变得更平滑。据我们所知，脾切除术后毛细胞的这种形态变化过去尚未见报道。其机制尚不清楚。我们推测脾切除术可能诱导分子或免疫变化，从而改变HCL细胞行为，这值得进一步研究。
