case_images: PMC10604644_01
case_images: Peripheral blood smear with monoclonal B-cells and smudge cells (Gumprecht shadows [13]) characteristic of CLL. Photos were obtained from the resources of the Department of Haemato-oncology and Bone Marrow Transplantation, Poland
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case_images: PMC10604644_01_CEJI-48-51328-g001.jpg
case_images: F1
case_images: The leukogram (Fig. 1) and peripheral blood immunophenotype results were presented by 43% of CD5+, CD19+, CD23+, CD20+, CD38+/-, CD200+, CD22+, CD43+, CD71-, sIgM-, sLambda-, sKappa+, ZAP-70+- B-cells (Fig. 2).
case_images: Re-analysis in 2021 of the patient's peripheral blood immunophenotype due to suspicion of disease progression. The diagnostic panel for B-NHL disorders contained anti-human mouse monoclonal antibodies CD45-FITC, CD14-PE, for the present patient. Tube II was composed of a combination of anti-CD5-FITC, anti-CD23-PE, anti-CD38-Per-Cy7, anti-CD19-APC, anti-CD20-APC-H7. The diagnostic panel for T-lymphocyte and NK-lymphocyte disorders contained anti-CD2-FITC, anti-CD5-PE, anti-CD7-Per-Cy7, anti-CD30-APC, anti-CD3-APC-H7 (Tube III). Tube IV was composed of a combination of anti-CytTdT-FITC, anti-CD2-PE, anti-CD7-Per-Cy7, anti-Cyt3-APC. Tube V was composed of a combination of anti-CD3-FITC, anti-CD8-PE, anti-CD45-Per-Cy7, anti-CD4-APC. Tube VI was composed of a combination of anti-3-FITC, anti-CD16+56-PE (BD Biosciences, US). An acquisition gate was put on lymphocytes in keeping with forward and side scatter (respectively: FSC, SSC) qualities. Lymphocytes accounted for 72.1% of peripheral blood cells. The positive subpopulation CD19+ was chosen from gate P2 (2.6%) and was set up individually with each of the markers: CD5+ (2.6%), CD23+ (0.7%), CD38+ (0.1%). B-cell lymphoproliferation was excluded. The diagnostic panel towards T/NK-lymphocyte disorders has been extended. The positive subpopulation CD7+ was chosen from gate P2 (64.0%) and was set up individually with each of the markers CD2+ (63.9%), CD3+ (20.2%), CD5+ (15.3%), CD30- (0.2%), Cyt3+/- (34.1%), CytTdT- (0.0%). In the last stage of the analysis, the CD56+16+ cells were gated (49.4%), which showed lack of CD3 (1.2%), CD4 (0.0%) and partially CD8 (17.3%) expression. Marker expression analysis using the flow cytometry of peripheral blood showed the presence of approx. 48.2% NK cells with CD7+, CD2+, CD3-, CD5-, CD30-, Cyt3+/-, TdT-, CD8+/-, CD4-, CD16+, CD56+ immunophenotype. ** Cyt - cytoplasmic
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case_images: PMC10604644_01_CEJI-48-51328-g006.jpg
case_images: F3
case_images: An analysis of marker expression using the flow cytometry of peripheral blood showed the presence of approximately 48.2% natural killer cells (NK cells) with CD2+, CD7+, CD3-, CD16+, CD56+, CD8+/-, CD4-, Cyt3+/-, CD38+, CD43+, CD5-, CD19-, CD30-, CD34-, TdT- immunophenotype (Fig. 3).
case_images: Bone marrow smear with mature chromatin lymphocytes. Point I. Visible nucleolus and granules in the cytoplasm. For comparison, point II. Other lymphocytes in the preparation. Photos were obtained from the resources of the Department of Haemato-oncology and Bone Marrow Transplantation, Poland
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case_images: PMC10604644_01_CEJI-48-51328-g007.jpg
case_images: F4
case_images: The presence of about 10.1% NK cells with the immunophenotype as above was confirmed in the bone marrow, and in the myelogram lymphocytes that may correspond to the morphology of NK cells were observed (Fig. 4).