Almost a Near Miss-Hairy Cell Leukemia

Abstract

Hairy cell leukemia (HCL) is an infrequently encountered chronic B-lymphocyte hematological malignancy, which is found to be more prevalent in males. HCL can present with a myriad of nonspecific symptoms involving the reticuloendothelial system. Usually, patients are diagnosed after an incidental finding of pancytopenia. In the majority of cases, HCL follows an indolent course, and many patients remain asymptomatic. Treatment with nucleoside analogs is the first line of treatment and is indicated for patients with severe anemia, thrombocytopenia, neutropenia, or severe systemic symptoms. Here, we report an atypical case of a 41-year-old Hispanic female who presented with menorrhagia and iron deficiency anemia. She was diagnosed with HCL after a bone marrow biopsy demonstrated the characteristic "hairy projections."

Hairy Cell Leukemia: Hepatic Affinity Status Post Splenectomy

“…Hairy cell leukemia is a lymphoproliferative disorder of mature B-cells that typically circulate through and proliferate in the reticuloendothelial system, leading to bone marrow suppression and splenomegaly [ 3 , 4 ]. Approximately 25% of cases are found incidentally in asymptomatic patients, with the remaining cases presenting symptoms that are a consequence of splenomegaly and cytopenias, including but not limited to generalized weakness, fatigue, infections, and bleeding.…”

“…Another common mutation associated with HCL is the cyclin-dependent kinase inhibitor 1B/p27 (CKDN1B/p27 cell cycle inhibitor inactivation). CDKN1B encodes for the p27 protein, which is an important regulator of the cell cycle and plays a significant role in cellular activities such as inhibition of cyclin-dependent kinase, regulation of apoptosis, and interaction with the cytoskeleton [3,[9][10][11]. Macroscopically, HCL-associated fibrosis occurs after infiltration into hyaluronic-rich tissues such as bone marrow and hepatic portal tracts.…”

“…HCL is a mature B-cell lymphoma characterized histologically as mononuclear cells with ovoid nuclei and abundant variable 'hair-like' cytoplasmic projections that circulate in the peripheral blood [ 2 ]. These hairy cells have a specific immunophenotype and generally express clonal clusters of differentiation (CD) antigen markers CD19, CD20, and CD22 that can be identified by flow cytometry [ 3 ]. No formal genetic abnormalities have been included in the diagnostic criteria; however, BRAF600E mutations have been implicated in the vast majority of HCL cases.…”