images in haematology
Huge kidneys in a patient with chronic lymphocytic leukaemia
A 59-year-old man was admitted with dyspnoea and vomiting. A blood count showed anaemia, thrombocytopenia and lymphocytosis (lymphocyte count 213 9 109/l). He had severe renal failure (serum creatinine 12848 lmol/l) with oliguria. Haemodialysis was promptly started. Flow cytometry immunophenotyping detected a clonal B-cell population (CD20+, CD5+, CD23+, CD3 , CD10 , FMC7 , CD79a+, CD79b , CD38 , ZAP70 with membrane kappa light chain restriction at low density) indicative of B-lineage chronic lymphocytic leukaemia (B-CLL). Computerized tomography (CT) scanning of the abdomen and pelvis revealed extensive lymphadenopathy, splenomegaly (spleen length 15 cm) and a striking increase in kidney size (length of right and left kidneys 15 and 14 cm, respectively) (top left); kidney biopsy showed extensive infiltration of the interstitium, tubules, glomeruli and vessels by lymphocytes of the same clone as was found in peripheral blood, with the proliferation fraction, evaluated by Ki67 expression, being
Huge kidneys in a patient with chronic lymphocytic leukaemia
A 59-year-old man was admitted with dyspnoea and vomiting. A blood count showed anaemia, thrombocytopenia and lymphocytosis (lymphocyte count 213 9 109/l). He had severe renal failure (serum creatinine 12848 lmol/l) with oliguria. Haemodialysis was promptly started. Flow cytometry immunophenotyping detected a clonal B-cell population (CD20+, CD5+, CD23+, CD3 , CD10 , FMC7 , CD79a+, CD79b , CD38 , ZAP70 with membrane kappa light chain restriction at low density) indicative of B-lineage chronic lymphocytic leukaemia (B-CLL). Computerized tomography (CT) scanning of the abdomen and pelvis revealed extensive lymphadenopathy, splenomegaly (spleen length 15 cm) and a striking increase in kidney size (length of right and left kidneys 15 and 14 cm, respectively) (top left); kidney biopsy showed extensive infiltration of the interstitium, tubules, glomeruli and vessels by lymphocytes of the same clone as was found in peripheral blood, with the proliferation fraction, evaluated by Ki67 expression, being
