Case 45

A 64-year-old man presented with lymphadenopathy and splenomegaly. Based on a limited immunophenotyping and his clinical condition, the patient was initially diagnosed with chronic lymphocytic leukemia/small lymphocytic lymphoma. The patient had a relatively stable clinical course for nine years. In the ninth year after the initial diagnosis, the patient’s leukocyte count went up to 120,000/μl with many blastoid cells (Fig. 45.1). A bone marrow biopsy confirmed blastoid transformation (Figs. 45.2 and 45.3). Subsequently, the patient developed neurologic and pulmonary symptoms. Blasts were found in the cerebrospinal fluid and bronchoalveolar lavage. The patient died nine months after the detection of blastoid cells. Autopsy showed systemic dissemination of lymphoma in practically all internal organs (Figs. 45.4 and 45.5) and lymph nodes (Fig. 45.6).