Chronic lymphocytic leukemia

Chronic lymphocytic leukaemia (CLL) is a haematological malignancy. 

Epidemiology

CLL is considered the most common type of leukemia in the Western hemisphere; its prevalence in Europe and North America ranges from 29-38% of all leukaemias ¹. It primarily affects adults ~65-70 years of age ³.

Clinical presentation

Up to half of patients can be asymptomatic with the disease being incidentally discovered by a routine blood work up ³. Patients may sometimes present with hepatomegaly, splenomegaly or both and/or a haemolytic anaemia.

Pathology

It is a B-lineage neoplasm of pre-follicular center cells that is usually associated with circulating neoplastic small lymphocytes. From a morphologic and immunophenotypic perspective, the malignant cells of CLL tend to be identical to those of nodal-based small lymphocytic lymphoma (SLL), and these two malignancies are thought to represent different manifestations of the same disease ¹.

Staging

There are two common staging system in use which are:

• Rai staging system
• Binet staging system

Diagnosis

The diagnosis is generally established by a bone marrow biopsy and immunophenotyping.

Radiographic features

Imaging may identify various features of the disease such as splenomegaly, hepatomegaly +/- lymphadenopathy, although these are not specific for the disease.

MRI

As with other typetypes of bone marrow infiltrative disease, it is possible to see a diffusely hypointense signal of bone structures on T1, easier to see on spinal MRI.

Complications

• Richter transformation: is defined as a diffuse large cell lymphoma, occurring by transformation of chronic lymphocytic leukemia ^2,4.

See also

• WHO classification of lymphoid neoplams