Chronic lymphocytic leukemia/small lymphocytic lymphoma is characterized by the accumulation of monomorphic, small B lymphocytes in the blood, bone marrow, lymph nodes, spleen, and other tissues. The lymphocytes typically express markers like CD5, CD19, and CD23 and have distinct clumped chromatin. Peripheral blood, bone marrow, lymph nodes, liver and spleen are usually involved. Clinical features are variable but often include fatigue, infections, enlarged lymph nodes, spleen and liver. Over time the disease may progress with increased cell size and proliferation.

1. CH.VYSHNAVI
MSC MLT 1STYEAR

3.  Chronic lymphocytic leukaemia small
lymphocytic lymphoma is a neoplasm
composed of monomorphic small, round to
slightly irregular B lymphocytes in the
peripheral blood ,bone marrow ,spleen and
lymph nodes, admixed with prolymphocytes
and paraimmunoblasts forming proliferation
centres in tissue infiltrates

4.  Peripheral blood and bone marrow are
usually involved
 Lymph nodes, liver and spleen are also
typically infiltrated , and other extra nodal
sites may occasionally be involved

5.  Clinical features are very variable including
presentation, course and out come
 Most of the patients are asymptomatic , but
some present with fatigue, autoimmune
haemolytic anaemia, infection,
splenomegaly, heptomegaly ,
lymphadenopathy or extra nodal infiltrates

6.  Healthy individuals may show monoclonal or
oligoclonal B-cell expansion with the
characteristic phenotype with the characteristic
phenotype of CLL
 Monoclonal B-cell lymphocytosis with a non-CLL
phenotype may correspond to similar
phenomena in other B-cell neoplasms
 Whether MBL is a predisposin condition or even
a precursor of overt CLLhas to be elucidated

7.  LYMPH NODESAND SPLEEN
 Enlarged lymph nodes in patients with
CLLSLL show effacement of the
architecture, with s pseudofollicular pattern
of regular-distributed pale areas
corresponding to proliferation centres
containg larger cells in a dark background of
small cells

8.  The predominant cell is a small lymphocyte,
which may be slightly larger than a normal
lymphocyte, with clumped chromatin ,usually
a round nucleus, and occasionally a small
nucleolus
 Mitotic activity is usually very slow
 Proliferation centres contain a continuum of
small , medium and large cells

9.  Prolymphocytes are small to medium sized
cells with relatively clumped chromatin and
small nucleoli
 Paraimmunoblasts are larger cells with round
to oval nuclei ,dispersed chromatin , central
eosinophilic nucleoli and slightly basophilic
cytoplasm

10.  On BM and PB smears , CLL cells are small
lymphocytes with clumped chromatin and
scanty cytoplasm
 Smudge or basket cells are typically seenn in
pb smear

 The proportion of prolymphocytes in pb is
usually <2%

11. CLL INTHE
PHERIPHERAL
BLOOD,THE CLL
LYMPHOCYTES
ARE
SMALL,ROUND
,WITH DISTINCT
CLUMPED
CHROMATIN.
SMUDGE CELLS
ARE COMMONLY
SEEN

12.  More than 55% prolymphocytes , however,
would favour the diagnosis of B-cell
prolymphocytic leukaemia [B-PLL]
 Atypical CLL shows less condensed nuclear
chromatin and nuclear irregularities in PB
lymphocytes
 Bone marrow involvement as seen in trephine
biopsies may be interstitial, nodular or diffuse;
proliferation centres are less common in the BM
than in lymphnodes

13.  The definition of minimal BM involvement
required to diagnose CLLSLL in the absence
of other defining features is not established,
although >30% lymphoid cells as
“characteristically” present

14.  Using flow cytometry, the tumor cells express
dim surface IgMIgD, CD20, CD22, CD5, CD19,
CD79a, CD23, CD43 and CD11c[week]
 CD10 is negative and FMC7 and CD79b are
usually negative or weekly expressed in
typical CLL
 The immunophenotype of PB lymphocytes
has been integrated into scoring system that
helps in the differential diagnosis between
CLL and other B-cell leukaemias

16.  New biological prognosis factor have become
increasingly important especially in early
stagee CLL
 Expression of ZAP-70 and CD38 are both
associated with an adverse prognosis

17.  Over time, CLL may show an increase in cell
size and proliferative activity as well as
confluence of proliferation centres in lymph
nodes an BM
 This may correlate with increase in
prolumphocytes in the PB
 Progression of CLL to B-PLL is extremely rare

18.  2-8% of patients with CLLdevelop diffuse
large B-cell lymphoma[DLBCL] and <1%
develop classical Hodgkin lymphoms
 The majority of the DLBCL have been
reported to be clonally related to the previous
CLL and are unmutated, whereas the clonally
unrelated cases of DLBCL usually occurred in
mutated CLL