Schleiffenbaum B E, Rüegg R, Zimmermann D, Fehr J
Department of Internal Medicine, University Hospital Zürich, Switzerland.
Eur J Haematol. 1996 Nov;57(5):341-8. doi: 10.1111/j.1600-0609.1996.tb01391.x.
According to international recommendations, the diagnosis of chronic lymphocytic leukaemia (CLL) is made on the grounds of persistent peripheral lymphocytosis or lymphocytic infiltration of the bone marrow. The appearance of morphologically atypical lymphocytes in low-grade malignant lymphoma (NHL) or CLL is easily overlooked, and is generally not regarded as a diagnostic criterion. We report 12 cases of CLL/NHL who were detected only by morphological screening of routine peripheral blood smears (83,400 blood smears). The diagnosis of CLL/NHL was not suggested by the patients' history, physical or other laboratory findings, and had not been contemplated by the physician in charge. Monoclonality of peripheral lymphocytes was confirmed by immunophenotyping and Southern blotting. The lymphoma was classified histologically according to the International Working Formulation (bone marrow biopsy). A monoclonal lymphatic population was not found by immunophenotyping in the blood of 11 patients whose lymphocytes were morphologically classified as activated-abnormal. However, 3 patients suspected to have NHL/CLL on morphological screening of blood smears had to be classified as benign after immunophenotyping. We conclude that morphological screening of routine blood smears is an inexpensive and easy additional screening method for CLL and low grade malignant NHL.
根据国际推荐标准，慢性淋巴细胞白血病（CLL）的诊断基于持续性外周淋巴细胞增多或骨髓淋巴细胞浸润。低级别恶性淋巴瘤（NHL）或CLL中形态学上不典型淋巴细胞的出现很容易被忽视，并且通常不被视为诊断标准。我们报告了12例仅通过常规外周血涂片形态学筛查（83400张血涂片）检测出的CLL/NHL病例。这些患者的病史、体格检查或其他实验室检查结果均未提示CLL/NHL的诊断，主管医生也未曾考虑过。通过免疫表型分析和Southern印迹法证实了外周淋巴细胞的单克隆性。根据国际工作分类法（骨髓活检）对淋巴瘤进行组织学分类。在11例淋巴细胞形态学分类为活化异常的患者血液中，免疫表型分析未发现单克隆淋巴细胞群。然而，在血涂片形态学筛查中疑似患有NHL/CLL的3例患者，免疫表型分析后不得不归类为良性。我们得出结论，常规血涂片形态学筛查是一种用于CLL和低级别恶性NHL的廉价且简便的附加筛查方法。
