GrannyBarb and Art's

Leukemia Links

Barb's Pathology Reports from St. John's Mercy Medical Center

St. Louis, Missouri 1996-1997

This page and the others like it including the slides and the flow cytometry reports have been added to Grannybarb's story at my own volition and with the knowledge of all my oncologists/hematologists. I am working with Gerald Marti, M.D., NIH, who hopes, as I do, that they will provide additional insight for professionals and patients who may be interested in the technical part of CLL. For those who are simply reading the story, please feel free to skip this part.

Contents

ST. LOUIS: St. Johns Mercy Medical Center

BONE MARROW REPORT

PATIENT: LACKRITZ, BARBARA Date: 5/23/97

DIAGNOSIS

    ANEMIA, NORMOCHROMIC, NORMOCYTIC.
    LEUKOPENIA.

    II. BONE MARROW, ASPIRATE AND BIOPSY:

    SMALL LYMPHOCYTIC LYMPHOMA/CHRONIC LYMPHOCYTIC LEUKEMIA
    (SEE COMMENT)
    INCREASED STORAGE IRON.

PERIPHERAL BLOOD SMEAR:

Red blood cells are normochromic normocytic. There is mild anisopoikilocytosis. Microcytic hypochromic forms are seen, as well as occasional stomatocytes and ovalocytes. Rare tear drop forms are also seen. Nucleated erythroids are absent. White blood cells are reduced to 3,500. In the differential count segmented neutrophils predominate. Occasional pseudo Pelger-Huet cells are seen; neutrophils are otherwise morphologically unremarkable. Occasional band forms and metamyelocytes are also noted. Lymphocytes are proportionately represented. Platelets are estimated at approximately 150,000. Large platelets are seen.

H & E SECTIONS:

A core biopsy and clot section are available for review. Cellularity in the core biopsy averages 50%. A mixed population of erythroid, granulocytic, and megakaryocytic elements is present. All cell lines show orderly maturation. Nodular, non-paratrabecular lymphoid aggregates are present. These are estimated to account for approximately 15% of the marrow volume. Lymphocytes are small with round nuclear contour and clumped chromatin. The clot sections consist mostly of erythrocytes and fibrin. A few cellular marrow particles are seen. A small lymphoid infiltrate is identified in this material. The overall features are histologically similar to the core biopsy.

BONE MARROW SMEARS:

The smears are hypocellular and unsuitable for formal cell count. The myeloid/erythroid ratio appears within normal limits. Maturation is orderly in both cell lines. Both cell lines show mild megaloblastoid nuclear changes. Scattered small lymphocytes are seen. These are estimated at less than 10% of the nucleated marrow cells.

DATE OF PROCEDURE: 05/23/97 LACKRITZ,BARBARA B
DATE OF ACCESSION: 05/23/97 07/16/1938 58Y F
CC:DENES, ALEX E., MD ONCOLOGY

SPECIAL STAIN:

An iron stain performed on the aspirate reveals increased reticuloendothelial iron. Sideroblastic iron is slightly decreased. Sideroblastic iron granules present are somewhat coarse.

COMMENT:

This is a 58 year old woman with a history of small lymphocytic lymphoma/chronic lymphocytic leukemia (BM97-151). In comparison to the previous bone marrow examination, there has been an interval decrease in the overall percentage of small lymphocytes to approximately 15% of the nucleated marrow cells.
PJC:ab D:05/24/97 T:05/24/97

DATE OF PROCEDURE: 05/23/97 LACKRITZ,BARBARA B
DATE OF ACCESSION: 05/23/97 07/16/1938 58Y F
CC: DENES, ALEX E., MD ONCOLOGY

BONE MARROW ENUMERATION

Reticulum Cell
Blast
Progranulocyte         (Promyelocyte)
Myelocyte:              Neutrophilic 
                        Eosinophilic 
                        Basophilic

Metamyelocyte:          Neutrophilic
                        Eosinophilic
                        Basophilic

Band:                   Neutrophilic
                        Eosinophilic
                        Basophilic

Segmented:              Neutrophilic
                        Eosinophilic
                        Basophilic

Lymphocyte
Monocyte
Plasma Cell
Mitotic Figure
Tissue Mast Cells
Rubriblast (Megaloblast)
Prorubricyte (Early Erythroblast)
Rubricyte (Late Erythroblast)
Metarubricyte (Normoblast)

ELECTRONIC SIGNATURE FOR PAULA J.CHOR,MD
05/24/97 13:37

DATE OF PROCEDURE: 05/23/97 LACKRITZ,BARBARA B
DATE OF ACCESSION: 05/23/97 07/16/1938 58Y F
CC. DENES, ALEX E., MD ONCOLOGY

PATIENT HISTORY

INDICATIONS FOR BONE MARROW: CLL follow up

PERIPHERAL BLOOD COUNTS

  3.5   WBC             Auto Differential:      Manual Differential:
  3.39  RBC              G    Lym %           _____  B Seg    ____ Blast
  9.7   Hgb              8.3  Gran %          _____  Band     ____ NRBC
 27.9   Hct              9    Mono %          _____  Lymph    ____ Normal RBC
 82.3   MCV              0    Eos %           _____  Mono     ____ Aniso
 28.6   MCH              2    Baso %          _____  Eos      ____ Poik
 34.7   MCHC                                  _____  Baso     ____ Micro
 15.0   RDW                                   _____  A Lymph  ____ Macro
153.    PLT                                   _____  Meta     ____ Poly
  8.0   MPV                                   _____  Meylo    ____ Hypo
                                              _____  Pro      ____  PLT Est

LACKRITZ BARBARA 3 05/23/97 58Y 3 SLIDES

ST. JOHN'S MERCY MEDICAL CENTER
CYTOGENETICS LABORATORY

PATIENT NAME: Barbara Lackritz
DATE SPECIMEN RECEIVED 4/11/97
REFERRING PHYSICIAN: Dr. DENES

Tissue Analyzed: Bone Marrow  
Staining:  GTG
No. of Cells Counted: 20
No. of Cells Analyzed: 20
No. of Cells Karyotyped: 2
RESULT: 46 XX . [20]
INTERPRETATION: Normal female karyotype.

Time: 400 PM Date: 4/28/97
By: Kutay Taysi M.D.
Director, Cytogenetic Laboratory

BONE MARROW REPORT

PATIENT: LACKRITZ,BARBARA B Date: 4/11/97

DIAGNOSIS

    ANEMIA, NORMOCHROMIC, NORMOCYTIC, MILD.

    II. BONE MARROW, ASPIRATE AND BIOPSY:

    SMALL LYMPHOCYTIC LYMPHOMA/CHRONIC LYMPHOCYTIC LEUKEMIA
    (SEE MICROSCOPIC DESCRIPTION)

Received are slides labeled BM97-151, Barbara Lackritz.

PERIPHERAL BLOOD SMEAR:

Red blood cells are normochromic normocytic. There is mild anisopoikilocytosis. Occasional ovalocytes are seen. There is minimal polychromasia. White blood cells are decreased to 4,600. In the differential count segmented neutrophils predominate. Cytoplasmic granules are prominent. Occasional band forms and isolated metamyelocytes are noted. Lymphocytes are decreased. Those present are activated in appearance. Platelets are estimated at 130,000. Occasional large platelets are noted.

H & E SECTIONS:

A clot section and core biopsy are available for review. Cellularity in the clot section averages 60%. A mixed population of hematopoietic elements is present. Orderly maturation is noted. Nodular and diffuse lymphoid infiltrates are present. These are composed of small lymphocytes with mostly round nuclear contour. Admixed are occasional prolymphocytes. The lymphocytes percentage is estimated at approximately 50%. The clot section consists of red cells.

BONE MARROW SMEARS:

This is a "dry tap." The bone marrow aspirate reflects sinusoidal blood. Granulocytic and erythroid elements are present. Dysplastic changes are not identified. Lymphocytes are admixed. The majority are small and round. Occasional larger lymphoid cells are seen.

SPECIAL STAIN:

An iron stain performed on the core biopsy reveals adequate reticuloendothelial iron. Immunoperoxidase stains were performed on the bone marrow biopsy. CD20, a B-cell associated marker, shows paramembranous reactivity with the majority of small lymphocytes. CD23, a marker associated with small lymphocytic lymphoma/chronic lymphocytic leukemia, showed pareamembranous reactivity with the majority of lymphoid appearing cells.

DATE OF PROCEDURE: 04/11/97 LACKRITZ, BARBARA B
DATE OF ACCESSION: 04/11/97 58Y F
DENES, ALEX E., MD

COMMENT:

This is a 58-year-old woman with a history of chronic lymphocytic leukemia She is undergoing reevaluation for autologous bone marrow transplant. Bone marrow examination reveals involvement of marrow in a nodular and diffuse pattern by chronic lymphocytic leukemia/ small lymphocytic lymphoma. Lymphocytes are estimated to account for approximately 50% of the marrow volume. There is no evidence of large cell transformation. The combination of expression of CD20 and CD23 on immunoperoxidase studies and coexpression of CD20/CD5 on limited flow cytometric examination support a diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma.
PJC :shm

DATE OF PROCEDURE: 04/11/97 LACKRITZ,BARBARA B
DATE OF ACCESSION; 04/11/97 58Y F
DENES, ALEX E., MD ONCOLOG

ST. LOUIS PATHOLOGY ASSOCIATES

BONE MARROW ENUMERATION

Reticulum Cell
Blast
Progranulocyte          (Promyelocyte)
Myelocyte:              Neutrophilic 
                        Eosinophilic 
                        Basophilic

Metamyelocyte:          Neutrophilic
                        Eosinophilic
                        Basophilic

Band:                   Neutrophilic
                        Eosinophilic
                        Basophilic

Segmented:              Neutrophilic
                        Eosinophilic
                        Basophilic

Lymphocyte
Monocyte
Plasma Cell
Mitotic Figure
Tissue Mast Cells
Rubriblast (Megaloblast)
Prorubricyte (Early Erythroblast)
Rubricyte (Late Erythroblast)

Metarubricyte (Normoblast)

ELECTRONIC SIGNATURE FOR PAULA J.CHOR,MD
04/17/97 13:37

DATE OF PROCEDURE: 04/11/97 LACKRITZ,BARBARA B
DATE OF ACCESSION: 04/11/97 58Y F
CC. DENES, ALEX E., MD ONCOLOGY

PATIENT HISTORY

PATIENT NAME Lackritz , Barbara DATE: 4/11/97 58Y F
PHYSICIAN: Denes, Alex MD

INDICATIONS FOR BONE MARROW:

HLO CLL Re-evaluation for autologous transplant flow cytometry for CD 23, CD 34 as well as routine flow.

PERIPHERAL BLOOD COUNTS

  4.6  WBC           Auto Differential       Manual Differential:      
  3.91 RBC              ____ Lym %           78 Seg    _____Blast
 11.9  Hgb              ____ Gran%           8 Band    _____NRBC
 34.7  Hct              ____ Mono%           4 Lymph   _____Normal RBC
 30.4  MCV              ____ Eos %           6 Mono    _____Aniso
 30.4  MCH              ____ Baso %          3 Eos     _____Poik
 30.4  MCHC                                  __Baso    _____Micro
 14.4 RDW                 K/L                __A Lymph _____Macro
130   PLT               CD 20 /S             1 Meta    _____Poly
  7.6 MPV               CD 19/23             __Meylo   _____Hypo
                        CD 2                 __Pro     _____PLT Est

LEUKEMIA/LYMPHOMA PANEL

PATIENT: LACKRITZ,BARBARA B 4/11/97

DIAGNOSIS

BONE MARROW, FLOW CYTOMETRY: B-CELL LYMPHOPROLIFERATIVE PROCESS.

SPECIMEN TYPE: 
ANTIBODIES- NUMBER: 
ANTIBODIES - COMMENT:
                        LYMPHOCYTE      MONONUCLEAR      MYELO
T-CELL/THYMOCYTES       REGION %        REGION %         REGION %
 CD2 (T11)
 CD3 (T3)
 CD4 (T4)
 CD5 (T1)
 CD8 (T8)

B-LYMPHOCYTE/PLASMA CELL
 CDl9 (B4)
 CD20 (B1)                60
 KAPPA
 LAMBDA
 IGM
 IGD
 IGG
MYELO - MONO/HISTIOCYTE 
 CD13 (MY7)
 CDl4 (MO2) 
 CD14 (MY4) 
 CD33 (MY9)


OTHERS - PAN LEUK, SPECIALTY MARKERS
 CD10 (CD10+/CDl9+)
 CD34 (HPCA)                                                                                                          
 CD45 (KC56)
 (B1 + T1) (20/5)         60(19 + 23)

PATHOLOGIST'S INTERPRETATION:

Flow cytometric immunophenotypic studies were performed on a bone marrow sample. The number of antibodies was limited by sample volume. In the gated lymphocyte region, approximately 60% of the cells coexpress the B-cell associated marker CD20, and the T-cell associated marker CD5. Kappa and lambda stains are not satisfactory. Other antibodies were not tested secondary to sample limitations.

COMMENT:

This is a 58-year-old woman with a history of chronic lymphocytic leukemia. A very limited flow cytometric study reveal a population of cells co-expressing CD2C and CD5. This immunophenotype is characteristic of chronic lymphocytic leukemia/small lymphocytic lymphoma.
PJC:djw D: 04/17/97 T: 04/17/97

ELECTRONIC SIGNATURE FOR PAULA J. CHOR, MD
04/23/97 10:51

DATE OF PROCEDURE: 04/11/97 LACKRITZ,BARBARA B
DATE OF ACCESSION: 04/11/97 58Y F
DENES, ALEX E., MD ONCOLOG

PROCEDURE:
Endoscopic ethmoidectomies arid maxillary antrostomies

PATHOLOGY REPORT 1

Date of Procedure: 11-26-96 LACKRITZ,BARBARA B

Surgeon: George Kroeger. M.D.

SURGICAL PATHOLOGY

DX AND ADDITIONAL PERTINENT INFORMATION:
CLL, chronic sinusitis

GROSS:

The specimen is received in two containers, each labeled Barbara Lackritz."

The first container is labeled "left sphenoethmoid contents" and consists of multiple pieces of soft, pink-tan tissue containing small bone fragments and measuring 2.5 x 2 x 0.4 cm in aggregate. The entire specimen is wrapped in lens tissue paper and submitted in cassette labeled A for decalcification.

The second container is labeled "right sphenoethmoid contents" and consists of multiple small pieces of soft, pink-tan tissue containing small bone fragments and measuring 3 x 2 x 0.4 Cm in aggregate. The entire specimen is wrapped in lens tissue paper and sub-mitted in cassette labeled B for decalcification.

BC.sla D: 11/26/96 T: 11/26/96

MICROSCOPIC:

Slides labeled S-15712-96. Barbara Lackritz

Sections A and B (left and right sphenoethmoid content) reveal several pieces of sinus lining mucosa. They are diffusely infiltrated by sheets of small lymphocytes with round hyperchromatic nuclei surrounded by scant cytoplasm. This diffuse lymphoid infiltrate is a manifestation of chro7)~%i„/7{0Sb' ¥cAX$,),6R MFOtp*')z-k 9SqEˊ&څ231I1V6oRa4bT9Ŏ޻ qՋI{zyԕ|@Wa4ٗ)0BQL9[b#3`U<L k Nw ,3=N|_ކC9/zzSӉ!ImnM7O0pSZCd A뎋W{Zr-7"{Y㩇o-aN\F!^~]C!{͵zԖ."82CL"PL=$p /Ȝ#j >DC+%Nr^D8*"l-;-{\rDŽh*d&7=/$.%/ZQiĖ)x̛7.v3bxR~x;40]@::- /i!5#AM?Ջk_u7)e {@dٳi?VUk<[_63GSx.qiܭ7R9(\X H=cMkq=W.~ZbWD5.aiV (ǮN@%|*췜Uބq8f̚`r8 k mI A9S' g&zզ cHqMNQING>Q{,̰cH_e#ߘpu(r3W .7]Սp xC8 Ek6lFM @b[gA\% a{#Ce5KN:cH aըR[84Wt+`zFPOM(*˅:\6Pzcgsg 1nhzuU?Sm_uB%]sD=>hN`*dz9I8_͗O46j]_D)Ԫ882֦FdVPP[m 8z*CoXV>9kO3[,+w+>ٞs3VZhܚ(tdK(4U]7Mܩ] )jQ|b*qɳ5oUY#dcƧw/⬎c)tE([#KBuu+3@UwH(G9;l l 3;; Rʥ>TeKIe#&J4X.wi7J?CM[P~L%t|s0~Y VŖWӅ,MsWt7N.r f-Cm6|bcs\ztG7\<1" -Z!<x@#$]wUo3i8ҿA l0 }74>(U4P҇DYbQS4yGļXWMȈ>^ iL vګ薼' & {6e ʩ+?%\F'I~7U(6)Y8boZ.On2bćC%laJpϲ.l#3wBnyP~ׁj <~X#Fnq~{$s# pRi}em.R+{U1WDQz%Q}[ү.U:;80|&pyE7U;s\b]}&y0ZB@pj -)"=bܘِݢلuŠ" 17 Ae}&VboXSNWN=AaAn\-VK˵V2ak"yKVԝg w`#7 kR__ \$Ode(2qpC39li2 weg`~o/unSxmcsO: PXP