“Soccer-Ball” Lymphocytosis
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Jena L. Utz
An 87-year-old man with a history of paroxysmal atrial fibrillation, hypertension, and chronic kidney disease presented to the emergency department with confusion, weakness, and shortness of breath with nonproductive cough. Laboratory studies revealed a white blood cell count of 41,300 × 109/L, an absolute lymphocyte count of 23,500 × 109/L, a hemoglobin level of 9.8 g/dL, a platelet count of 280,000 × 109/L, and a creatinine level of 1.16 mg/dL. On physical examination, the patient had no hepatosplenomegaly, lymphadenopathy, bruising, or bleeding. An evaluation for infection or autoimmune conditions was unrevealing. A peripheral blood smear revealed smudge cells (image A) and small round lymphocytes with coarsely clumped chromatin (image B) characteristic of chronic lymphocytic leukemia (CLL; Wright-Giemsa stain).
Chronic lymphocytic leukemia typically presents with an increased number of small mature lymphocytes and smudge cells.1 Some refer to these cells as “soccer-ball” lymphocytes because the nucleus is very mature, dark, and can have a “cracked” appearance.2 Flow cytometry analysis detected κ monotypic B-cells with a non-CLL immunophenotype clone (positive CD19, dim CD20, negative CD5 and CD23 expression). Monoclonal B lymphocytosis, a precursor form of CLL, was diagnosed. Marginal zone and lymphoplasmacytic lymphoma were also considered. Bone marrow biopsy was planned, but the patient left the hospital before his procedure and was lost to follow-up.
References
1. InamdarKV, Bueso-RamosCE. Pathology of chronic lymphocytic leukemia: an update. Ann Diagn Pathol. 2007;11(5):363-389. doi:j.annadiagpath.2007.08.002Search in Google Scholar
2. ZhaoXF. Pitfalls in diagnostic hematopathology: part I. Int J Clin Exp Pathol. 2009;2(1):11-20.Search in Google Scholar
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Articles in the same Issue
- LETTERS TO THE EDITOR
- Helping Students Navigate the Single Graduate Medical Education Accreditation System
- More Information on Osteopathic Manipulative Medicine Consultations for Hospitalized Patients
- JAOA/AACOM MEDICAL EDUCATION
- Interprofessional Education on Medication Adherence: Peer-to-Peer Teaching of Osteopathic Medical Students
- Academic Advising Using Theoretical Approaches for Medical Students Who Are Struggling in Preclinical Years
- Assessment of the Research Interests and Perceptions of First-Year Medical Students at 4 Colleges of Osteopathic Medicine
- Relationship of Clinical Skills Performance in Medical School With COMLEX-USA Level 2-Performance Evaluation
- Success Predictors For Third-Year Osteopathic Medical Students on National Standardized Examinations: A Family Medicine Clerkship Course Study
- Empathy in MedicineCultivating an Empathetic Professional Identity in Osteopathic Medical Students Through Service Learning: A Qualitative Analysis of Reflective Essays
- Developing Neuraxial and Regional Pain Procedural Skills Through Innovative 3-Dimensional Printing Technology
- CASE REPORT
- Painful Proximally Oriented Large Heterotopic Spur Formation in an Active Adult With a Nontraumatic Amputation
- CLINICAL IMAGES
- “Soccer-Ball” Lymphocytosis
