Abstract
Hairy cell leukemia is a chronic B cell lymphoproliferative disorder,which is uncommon and constitutes around two percent of hematolymphoid malignancies. HCL commonly involves bone marrow and spleen and rarely peripheral blood . Splenomegaly is a prominent feature and is seen in around 70 to 100% of HCL cases as reported in various case reports. Sometimes the absence of splenomegaly rules out the diagnosis of HCL and is misdiagnosed as aplastic anemia. Thus the aim of our study is to understand the importance and keep a high level of suspicion in such cases. As in present case there was no evidence of splenomegaly clinically or radiology, but the morphologic features on biopsy had suggested HCL which was further confirmed on immunophenotyping. The purpose of this case report is to highlight the importance of the fact that HCL can present even without splenomegaly.
 Keywords: Hairy cell leukemia, Splenomegaly, Immunohistochemistry
Highlights
Hairy cell leukemia (HCL) is a chronic B cell lymphoproliferative disorder,which is uncommon and constitutes around two percent of hematolymphoid malignancies
Sometimes the absence of splenomegaly rules out the diagnosis of HCL and is misdiagnosed as aplastic anemia
As in present case there was no evidence of splenomegaly clinically or radiology, but the morphologic features on biopsy had suggested HCL which was further confirmed on immunophenotyping
Summary
Hairy cell leukemia (HCL) is a chronic B cell lymphoproliferative disorder,which is uncommon and constitutes around two percent of hematolymphoid malignancies. It is common in middle-aged to elderly and presents mainly with Pancytopenia, monocytopenia and splenomegaly. As in our case there was no evidence of splenomegaly clinically or on imaging investigation, but the morphological features on biopsy had suggested HCL which was further confirmed on immunophenotyping. Bone marrow biopsy showed intervening hypercellular marrow with interstitial increase in atypical lymphoid cells. These cells are small to intermediate in size, have scant to moderate cytoplasm, round nuclei & clumped chromatin. Figure-3: Immnohistochemcal stain on bone marrow biopsy (400x) shows CD 20 immunoreactivity in atypical cells
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