A patient has a white cell count of 12.6 x 109/L, hematocrit of 28%, and platelet count of 27 x 109/L
Examination of a Wright-stained blood film reveals that almost all of the white cells in peripheral blood are blasts; the bone marrow is hypercellular with very little fat and is packed with blasts. Flow cytometry is performed on the peripheral blood cells, and a large cluster of cells is present that mark with CD20 and have monoclonal k light chains present on their surface. This patient has a:
a. Myeloid leukemia
b. Mature B-cell malignancy
c. Reactive B-cell hyperplasia
d. Mature T-cell malignancy
ANS: B
Mature B lymphocytes express CD20 and either k or l light chains on their surface. In a B-cell reactive process, a mixture of k and l light chain positivity will be observed. The expression of only one light chain on the surface of a population of B cells is called monoclonality and is indicative of a phenotypically mature B-cell malignancy.
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