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Bone marrow (BM) biopsy of a case with synchronous chronic lymphocytic leukemia (CLL)/small lymphocytic leukemia (SLL) and hairy cell leukemia (HCL). (A-D) BM core biopsy specimen showing an abnormal lymphoid infiltrate with a diffuse growth pattern. The infiltrate is positive for CD20 (B), and negative for CD5 and CD23 [(C,D), respectively], consistent with involvement by HCL. The CLL infiltrate is focally present in the core biopsy (1% of the BM space; data not shown). (E) The corresponding flow cytometric analysis shows two distinct monoclonal populations: a CD20 dim+, CD5+, CD103-, CD11c-, lambda restricted CLL/SLL population (in blue) and a CD20 bright+, CD5-, CD103+, CD11c+, lambda restricted HCL population (in red). The HCL population is also positive for CD25 (data not shown).
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B-cells (CD19+/CD20+/CD5+/CD23+/moderate-density lambda+) and the second very small population (bright CD19+/bright CD20+/bright CD11c+/CD25+/CD103+/moderate lambda+), consistent with HCL. BM biopsy then demonstrated HCL, involving 20% of the BM space and CLL, involving 1% of the BM space (Figure 1).
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