Participant Instructions: Welcome to the Molecular Oncology Tumor Board Series! This educational initiative is a collaboration between the American Society of Clinical Oncology (ASCO), College of American Pathologists (CAP), and Association for Molecular Pathology (AMP).
A new case will be presented each month with discussions led by an expert pathologist and medical oncologist. This month’s topic is led by Drs. Nathanael Bailey (Pathologist from the University of Pittsburgh) and Sameer Parikh (Hematologist/Medical Oncologist from the Mayo Clinic).
Do you have an interesting case in mind? Submit your hypothetical patient cases for consideration in an upcoming Molecular Oncology Tumor Board discussion forum.
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Patient Case
A 62-year-old male with past history of hypertension and atrial fibrillation presents to his primary care physician with complaints of fatigue of 6 months duration. On exam, he is noted to have bilateral cervical and axillary lymphadenopathy, measuring 3 x 2 cm in size. There is no hepatosplenomegaly noted. There is no family history of leukemia/lymphoma.
Laboratory profile shows that the total WBC count is 35 x 109/L, with 98% lymphocytes, HB is 10 gm/dL, and PLT are 90 x 109/L. Serum chemistries are unremarkable.
Images
A CT scan of the chest, abdomen and pelvis shows generalized lymphadenopathy with the largest lymph nodes in the axillary area bilaterally measuring 5 x 5 cm.
Pathology
Microscopic examination of the peripheral blood demonstrated lymphocytosis with numerous “smudge” cells and lymphocytes with highly condensed chromatin. Flow cytometric immunophenotyping demonstrated a monotypic population of B-cells with expression of CD5, dim CD20, CD19, dim surface kappa light chains, CD23, and CD200, without significant expression of CD10, FMC7, CD49d, or CD38.
A bone marrow biopsy demonstrated a nodular and interstitial lymphoid infiltrate that constituted greater than 90% of marrow cellularity. Background hematopoiesis was markedly reduced. By immunohistochemical staining, the lymphocytes were positive for CD20 and LEF1, and they were negative for cyclin D1 expression. The combined morphologic and phenotypic characteristics of the lymphoid cells are diagnostic for chronic lymphocytic leukemia/small lymphocytic lymphoma.
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