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Endgames Spot Diagnosis

Interesting case of lymphocytosis and splenomegaly

BMJ 2016; 352 doi: (Published 03 March 2016) Cite this as: BMJ 2016;352:i1227
  1. Selina J Chavda, specialist registrar in haematology and National Institute for Health Research academic clinical fellow1,
  2. Claire Dearden, consultant in haematology1
  1. 1Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
  1. Correspondence to: S J Chavda selinachavda{at}

An 81 year old woman was referred to haematology with a six month history of fever, 7 kg weight loss, night sweats, and abdominal distension. She was otherwise fit and well; she had no travel history of note and did not smoke or drink alcohol.

On examination, she had massive splenomegaly palpable to the level of the umbilicus. The examination was otherwise normal and she had no palpable lymphadenopathy in the cervical, axillary, or inguinal regions.

Blood results showed haemoglobin 119 g/L (reference range 123-167), white blood cell count 68.0×109/L (3.5-11), lymphocytes 53.0×109/L (1.0-3.0), neutrophils 4.1×109/L (2.0-7.0), monocytes 6.8×109/L (0.2-1.0), and platelets 134×109/L (150-410). Urea, creatinine, and liver function tests were normal. A peripheral blood smear was performed (fig 1). Flow cytometry showed that 60% of total peripheral blood leucocytes were CD19, CD20, CD22, CD79b, CD25, CD11c, and CD103 positive surface immunoglobulin …

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