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74Abnormalities of the White Cell SeriesChronic Lymphocytic Leukemia (CLL) and Related DiseasesA chronic lymphadenoma, or chronic lymphocytic leukemia, can sometimesbe clinically diagnosed with some certainty. An example is the caseof a patient (usually older) with clearly enlarged lymph nodes and significantlymphocytosis (in 60% of the cases this is greater than 20 000/µl andin 20% of the cases it is greater than 100 000/µl) in the absence of symptomsthat point to a reactive disorder. The lymphoma cells are relativelysmall, and the nuclear chromatin is coarse and dense. The narrow layer ofslightly basophilic cytoplasm does not contain granules. Shadows aroundthe nucleus are an artifact produced by chromatin fragmentation duringpreparation (Gumprecht’s nuclear shadow). In order to confirm the diagnosis,the B-cell markers on circulating lymphocytes should be characterizedto show that the cells are indeed monoclonal. The transformedlymphocytes are dispersed at varying cell densities throughout the bonemarrow and the lymph nodes. A slowly progressing hypogammaglobulinemiais another important indicator of a B-cell maturation disorder.Transition to a diffuse large-cell B-lymphoma (Richter syndrome) israre: B-prolymphocytic leukemia (B-PLL) displays unique symptoms. Atleast 55% of the lymphocytes in circulating blood have large centralvacuoles. When 15–55% of the cells are prolymphocytes, the diagnosis ofatypical CLL, or transitional CLL/PLL is confirmed. In some CLL-like diseases,the layer of cytoplasm is slightly wider. B-CLL was defined as lymphoplasmacytoidimmunocytoma in the Kiel classification. According tothe WHO classification, it is a B-CLL variation (compare this with lymphoplasmacyticleukemia, p. 78). CLL of the T-lymphocytes is rare. The cellsshow nuclei with either invaginations or well-defined nucleoli (T-prolymphocyticleukemia). The leukemic phase of cutaneous T-cell lymphoma(CTCL) is known as Sézary syndrome. The cell elements in this syndromeand T-PLL are similar.Fig. 23 CLL. a Extensive proliferation of lymphocytes with densely structured nuclei and little variation in CLL. Nuclear shadows are frequently seen, a sign ofthe fragility of the cells (magnification 400). b Lymphocytes in CLL with typicalcoarse chromatin structure and small cytoplasmic layer (enlargement of a sectionfrom 23 a, magnification 1000); only discreet nucleoli may occur. c Slightlyeccentric enlargement of the cytoplasm in the lymphoplasmacytoid variant ofCLL.
Monotonous proliferation of small lymphocytes suggests chroniclymphocytic leukemia (CLL)abcdeFig. 23 d Proliferation of atypical large lymphocytes (1) with irregularly structurednucleus, well-defined nucleolus, and wide cytoplasm (atypical CLL or transitionalform CLL/PLL). e Bone marrow cytology in CLL: There is always strongproliferation of the typical small lymphocytes, which are usually spread out diffusely.75
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iiiColor Atlas of HematologyPractic
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vPrefaceOur Current EditionAlthough
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viiContentsPhysiology and Pathophys
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ContentsixAcute Lymphoblastic Leuke
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2Physiology and Pathophysiology of
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Page 34 and 35: 24Physiology and Pathophysiology of
Page 36 and 37: 26Physiology and Pathophysiology of
Page 39 and 40: Normal Cells of the Blood andHemato
Page 41: Normally erythropoiesis takes place
Page 44 and 45: 34Normal Cells of the Blood and Hem
Page 49 and 50: Advancing nuclear contraction and s
Page 51: Note the granulations, inclusions,
Page 71 and 72: Abnormalities of the White Cell Ser
Page 73 and 74: Predominance of Mononuclear Round t
Page 77 and 78: During lymphatic reactive states, v
Page 79 and 80: Extreme transformation of lymphocyt
Page 83: Predominance of Mononuclear Round t
Page 87 and 88: Atypical lymphocytes are not part o
Page 89 and 90: Deep nuclear indentation suggests f
Page 91 and 92: Cytoplasmic processes the main feat
Page 93 and 94: Plasmacytoma cannot be diagnosed wi
Page 95 and 96: Atypias and differential diagnoses
Page 97 and 98: Bone marrow diagnosis is indicated
Page 99 and 100: Conspicuously large numbers of mono
Page 107 and 108: Fundamental characteristic of acute
Page 109 and 110: The diagnosis of acute leukemia is
Page 111 and 112: Acute leukemias may also derive fro
Page 113 and 114: New WHO classification: AML with dy
Page 115 and 116: The cells in acute lymphocytic leuk
Page 117 and 118: In unexplained anemia and/or leukoc
Page 119 and 120: The classification of myelodysplasi
Page 121 and 122: Prevalence of Polynuclear (Segmente
Page 123 and 124: Predominance of the granulocytic li
Page 125 and 126: Prevalence of Polynuclear (Segmente
Page 127 and 128: Left shift as far as myeloblasts, p
Page 129 and 130: Bone marrow analysis is not obligat
Page 131 and 132: In the course of chronic myeloid le
Page 133 and 134: Enlarged spleen and presence of imm
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Eosinophilia and basophilia are usu
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Erythrocyte and ThrombocyteAbnormal
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Hypochromic Anemias129Insufficient
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Hypochromic Anemias131BSGIron Ferri
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Small, hemoglobin-poor erythrocytes
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Hypochromic erythrocytes of very va
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Hypochromic Anemias137Hypochromic S
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Hypochromic anemia without iron def
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Consistently elevated “young” e
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Distribution pattern and shape of e
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Conspicuous erythrocyte morphology
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Unexplained decrease in cell counts
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Hypochromic Anemias149Differential
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Thrombocytopenia with leukocytosis
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Conspicuous large erythrocytes sugg
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In older patients, myelodysplastic
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Small inclusions are usually a sign
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PlasmodiumfalciparumPlasmodiumvivax
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Conspicuous erythrocyte inclusions
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Bone marrow analysis contributes to
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Thrombocytes: increases, reductions
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Thrombocytes: increases, reductions
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Variant forms of thrombocyte and me
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Thrombocyte proliferation with larg
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Cytology of Organ Biopsiesand Exuda
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Lymph Node Cytology175Anamnesis- su
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Reactive lymph node hyperplasia and
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Lymph Node Cytology179Contact witha
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Epithelioid cells dominate the lymp
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In cases of non-Hodgkin lymphoma an
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Accessible cysts (e.g., branchial c
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Tumor cells can be identified in pl
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Viral, bacterial, and malignant men
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191IndexAActinomycosis 179Addison d
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Index193Disseminated intravascularc
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Index195blast crisis 120-121bone ma
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Index197in hemolytic anemia 140orth
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