Lymphoma & related disorders
Mature B cell neoplasms
Small B cell lymphomas with a circulating component
Prolymphocytic leukemia

Topic Completed: 1 March 2011

Minor changes: 11 May 2021

Copyright: 2001-2021,, Inc.

PubMed Search: b cell prolymphocytic leukemia

Nikhil Sangle, M.D.
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Cite this page: Sangle N. Prolymphocytic leukemia. website. Accessed June 16th, 2021.
Definition / general
  • Rare (2% of chronic lymphoid leukemias) disorder with prolymphocytes representing > 55% of leukemic infiltrate
Clinical features
  • Elderly men with peripheral blood lymphocytosis > 100,000, marked splenomegaly
  • 80% are B cell, 20% are T cell
  • B-PLL has better prognosis than T-PLL patients, but still considered incurable
Case reports
Microscopic (histologic) description
  • Involves red and white pulp of spleen and peripheral blood
  • Prolymphocytes in peripheral blood are large cells with scant to moderate pale blue agranular cytoplasm, round to polygonal nuclei and prominent central nucleoli; may have occasional nuclear grooves
  • T prolymphocytes have very irregular nuclear outlines, and cytoplasmic protrusions or blebs
Peripheral smear images

Case #120

Peripheral smear (blood) images

Positive stains
Flow cytometry description
  • Monomorphic B cell population that expresses CD19, CD20, CD79a, CD22, FMC7 with monotypic light chains; CD5 and CD23 in about 20% of cases (Semin Oncol 2006;33:257)
  • T prolymphocytes express CD2, CD3, CD7, CD52, TCL1 (oncogene); can co-express CD4 and CD8; are negative for TdT and CD1a
Flow cytometry images

Case #120

Flow cytometry images

Molecular / cytogenetics description
  • 14q+ is most common
  • Cytogenetic abnormalities are complex, suggesting clonal evolution and genomic instability
Differential diagnosis
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