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Reassessment of small lymphocytic lymphoma in the era of monoclonal B-cell lymphocytosis Gibson SE; Swerdlow SH; Ferry JA; Surti U; Dal Cin P; Harris NL; Hasserjian RPHaematologica 2011[Aug]; 96 (8): 1144-52BACKGROUND: In the 2008 World Health Organization classification, small lymphocytic lymphoma is defined as a neoplasm with the tissue morphology and immunophenotype of chronic lymphocytic leukemia, but with absence of leukemia. Minimal criteria of tissue involvement to separate small lymphocytic lymphoma from monoclonal B-cell lymphocytosis have not been defined. DESIGN AND METHODS: We reviewed the clinicopathological features of 36 patients with extramedullary tissue biopsies containing chronic lymphocytic leukemia-type cells and less than 5x10(9)/L peripheral blood monoclonal B cells. Pathological features (extent and patterns of involvement, architectural preservation, presence of proliferation centers) as well as cytogenetic and radiological findings were examined in relation to clinical outcome. RESULTS: The biopsies were performed to evaluate lymphadenopathy in 20 patients and for other reasons (most frequently staging of a non-hematologic neoplasm) in 16 patients. At latest follow-up (median 23 months), 21 untreated patients had no or stable lymphadenopathy, 3 had regressed lymphadenopathy, and 12 had developed progressive lymphadenopathy and/or received therapy for chronic lymphocytic leukemia/small lymphocytic lymphoma. Features associated with progression/treatment included lymph nodes 1.5 cm or greater on imaging studies (P=0.01) and presence of proliferation centers in the biopsied tissue (P=0.004). Neither the size nor extent of involvement of the excised lymph node correlated with progression/treatment. CONCLUSIONS: Our findings suggest that biopsies containing chronic lymphocytic leukemia-type cells, but lacking proliferation centers and with non-enlarged or only slightly enlarged lymph nodes on imaging, represent a very indolent disease that may best be considered a tissue equivalent of monoclonal B-cell lymphocytosis rather than overt small lymphocytic lymphoma. We propose that such cases be designated as tissue involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma-like cells of uncertain significance.|Aged[MESH]|Aged, 80 and over[MESH]|Cytogenetic Analysis[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Immunophenotyping[MESH]|Leukemia, Lymphocytic, Chronic, B-Cell/*diagnosis/pathology[MESH]|Lymph Nodes/pathology[MESH]|Lymphocytosis/*diagnosis/pathology[MESH]|Male[MESH]|Middle Aged[MESH] |
