Abstract
The diagnosis of chronic lymphocytic leukemia (CLL) presenting with ascites is predominantly based on the morphological and immunophenotypic characteristics, which are comparable to peripheral blood and bone marrow cells. However, it is relatively difficult to diagnose CLL due to the pleomorphism of the lymphocytes in ascites. The current study presents an 80-year-old male with a prior diagnosis of CLL who developed large ascites. Predominant T lymphocytes rendered morphological and immunophenotypic diagnosis difficult. Clonality analysis of immunoglobulin (Ig) gene rearrangements was performed on the lymphocytes from the ascites to diagnose the involvement of CLL, a laparotomy and biopsy from the peritoneal node confirmed the involvement of small lymphocytic lymphoma/CLL. The clonality analysis of Ig gene rearrangements may provide a powerful and accurate method for diagnosing CLL presenting with ascites.
Highlights
Chronic lymphocytic leukemia (CLL) is one of the chronic lymphoproliferative disorders that is predominantly diagnosed in the elderly
>100 cases of CLL are diagnosed in Taiwan, R.O.C. [1], with ~25% of patients initially asymptomatic at diagnosis and referred to the clinic due to an abnormal white blood cell count (WBC)
Immunophenotyping of lymphocytes in the peripheral blood revealed cluster of differentiation (CD)5(+), CD20(+) and CD23(+), which was compatible with B‐cell CLL
Summary
The current case report presents an 80‐year‐old male with a history of hypertension who underwent medical treatment for 15 years. Complete blood counts were as follows: Hemoglobin, 11.5 g/dl; platelet count, 106x109 cells/l; WBCs, 7.8x109 cells/l; segments, 63%; lymphocytes, 30.8%; monocytes, 5.3%; eosinophils, 0.6%; and basophils, 0.3%. An abdominal CT scan showed enlarged mesenteric nodes with a progressive change of mesenteric inflammatory disease compared with the CT results at diagnosis. An explorative laparoscopy was performed to exclude peritonitis, second malignancy or large cell transformation, and large ascites with multiple white small lymph nodes over the peritoneum were identified. Further immunohistochemical staining was positive for CD20, CD5, CD23 and negative for CD10 and cyclin D1 These findings were compatible with CLL involving the peritoneum. The patient subsequently received prednisolone and chlorambucil therapy, and the ascites rapidly regressed and disappeared after one month
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