Marked Retroperitoneal Lymphadenopathy in Hairy Cell Leukemia: A Case Report
A 73-year-old male presented with a diagnosis of acute respiratory and renal failure, a large abdominal mass, ascites, a white blood cell count of 8.09 × 103/μl, a hemoglobin value of 12.5 g/dl, and a hematocrit value of 36.1%. His past medical history included splenectomy, hypertension, and a diagnosis of HCL from 12 years earlier. Prior to admission the patient had a 1-month history of positional discomfort, with occasional nausea and vomiting, and a 1-week history of painless jaundice. Abdominal axial computed tomography (CT) with intravenous and gastrointestinal contrast revealed a large retroperitoneal mass encasing the superior mesenteric artery, displacing the stomach and infiltrating into the liver (fig. ). The patient was transferred to the medical Intensive Care Unit for further management and placed on a ventilator. After discussion with the attending physician, the family requested the patient be extubated and pronounced ‘do not resuscitate’. The patient died the following day.\nAutopsy revealed moderate ascites consisting of serosanguineous fluid (550 ml) and 2 retroperitoneal masses. The first mass was 3.5 cm below the xyphoid process and measured 7.7 × 5.0 × 3.5 cm. The second mass was immediately below the first and measured 16.0 × 10.0 × 9.5 cm. Approximately 80% of the larger mass was removed and weighed 825 g. No nodal enlargement was found below the aortic bifurcation. Histologic examination of the mass by standard hematoxylin and eosin (HE) staining revealed extensive HCL cells (fig. ). Additionally, IHC analysis revealed that the tumor cells were CD20 and tartrate-resistant acid phosphatase (TRAP) positive (fig. ). The IHC analysis was performed in the LSU Health Shreveport Pathology Histology Immunohistochemistry Procedures Pathology Services using antibodies from Cell Marque (Rocklin, Calif., USA) following the manufacturer's recommended protocols.