A 48 year of woman was admitted with a history of weakness for two months. On examination cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl. platelet count 237 x 109/L, and total leukocyte count 40 x 109/L, which include 80% mature lymphoid cell with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20 and were negative for CD79B and FMC(-7). Which one of the following statements in not true about this disease?
A 48 year of woman was admitted with a history of weakness for two months. On examination cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl. platelet count 237 x 109/L, and total leukocyte count 40 x 109/L, which include 80% mature lymphoid cell with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20 and were negative for CD79B and FMC(-7). Which one of the following statements in not true about this disease?
💡 Explanation
**Core Concept**
The patient's presentation suggests a diagnosis of Chronic Lymphocytic Leukemia (CLL), a type of cancer that affects the blood and bone marrow, characterized by the production of an excessive number of immature white blood cells, known as lymphocytes. **CLL** is typically marked by the presence of mature lymphoid cells with coarse clumped chromatin. The diagnosis is often made based on the immunophenotypic profile of the lymphocytes, including positivity for **CD19**, **CD5**, and **CD20**.
**Why the Correct Answer is Right**
The description provided matches **CLL**, which is known for its specific immunophenotypic markers. The presence of **CD19**, **CD5**, and **CD20** positivity along with negativity for **CD79B** and **FMC7** is characteristic of CLL. The clinical presentation, including lymphadenopathy, splenomegaly, and anemia, also aligns with CLL.
**Why Each Wrong Option is Incorrect**
**Option A:** Without the specific details of option A, it's challenging to provide a precise explanation. However, in the context of CLL, any option suggesting a different typical immunophenotype or clinical behavior not aligned with CLL would be incorrect.
**Option B:** Similarly, without specifics, any statement contradicting known characteristics of CLL, such as its chronic course, would be incorrect.
**Option C:** This option would be incorrect if it suggested CLL is typically associated with a different set of immunophenotypic markers or clinical features.
**Option D:** If option D stated that CLL cells are typically positive for **CD79B** and **FMC7**, it would be incorrect, as CLL cells are usually negative for these markers.
**Clinical Pearl / High-Yield Fact**
A key point to remember in CLL is the distinction between typical CLL cells, which are **CD5** and **CD20** positive but **CD79B** and **FMC7** negative, and other lymphoproliferative disorders. The presence of lymphadenopathy, splenomegaly, and specific immunophenotypic markers can help in diagnosing CLL.
**Correct Answer:** Correct Answer: D. CLL cells are typically negative for CD79B.
✓ Correct Answer: D. t (11;14) translocation is present in most of the cases
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