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A 69-year-old womanwas examined due to abnormal pulmonary shadows on her chest roentgenogram. Although small lymphocyte proliferation was revealed in specimens by transbronchial lung biopsy (TBLB), immunoglobulin light chain restriction could not be seen. We attempted to verify the B-cell clonality by broncho-alveolar lavage (BAL) and a new sensitive method called k-X imaging (KLI), which was available for the detection of monoclonal B cells.

A 56-year-old male was admitted to our hospital with lymphocytosis (16.4 X 109/l; 79% lymphocytes including 50% small lymphocytes), generalized lymphadenopathy, massive spleno megaly, and heavily infiltrated bone marrow. Immunophenotype analysis of the neoplastic cells in the bone marrow revealed that they were B cells (CD20+CD19+Ial+sIgM+) positive for CD10. By contrast, the cells in the lymph node were CD20+CD19+Ial+sIgM+ but negative for CD10. The patient was tentatively diagnosed as having lymphosarcoma cell lymphoma, however, the final diagnosis was leukemic phase of intermediate lymphocytic lymphoma. We concluded that CD10+ neoplastic cells in the bone marrow and peripheral blood had dif ferentiated to CD10-cells. (Internal Medicine 31: 553-556, 1992)