Exact diagnosis of bushy cell leukemia rests upon the cells’ acknowledgment in blood, bone marrow, or spleen. Morphologic observation of these pathognomonic cells is more workmanship than science. This trenchant observation of Yam and colleagues is as pertinent today as when it was composed in 1972 and emphasizes that, despite the constantly developing battery of auxiliary studies to assist the hematopathologist, the distinguishing proof of cytologically characteristic cells remains the diagnostic sine qua non of HCL. Here we will spot the light on shaggy cells in fringe blood.
Treatment and diagnosis
Shaggy cells get their name from the sporadic fine cytoplasmic projections that reach out for variable distances from the fringe. It is, in any case, a mix of characteristics that identifies the HC in Romanowsky preparations (e.g. Wright stain). The unusual nucleus with its fine chromatin condensation, the pale slate-blue cytoplasm and the fine surface projections all structure a starting’s piece diagnostic impression.HC surface morphology is best valued by phase microscopy of a suitable “wet” readiness of moving cells in suspension and here the run of the mill villous nature of the HC are easily welcomed.
In Wright-stained preparations, the furry cell is 1.5 to 2 times the size of a full grown lymphocyte and the nucleus occupies one half to two thirds of the cell’s region. HCL tends to be a disease of monotonous cells with respect to cytologic characteristics and size. Henceforth, in spite of the fact that there may be a moderate level of cell size variety between patients, an individual patient usually displays an amazingly homogeneous populace of bushy cells. The cores can have several configurations, including round, oval, spindled, reniform, horseshoe-shaped, and bilobed. Despite the fact that the bristly cells in an individual differ in atomic contours, most patients have a prevalent atomic shape, most ordinarily oval. Despite variety in atomic shape, there are several consistent atomic characteristics of HCL that assist enormously in acknowledgment. Most vital, the atomic film is almost always smooth, bestowing a distinct division from the surrounding cytoplasm and without the fine surface irregularities that epitomize numerous other lymphoproliferative disorders. As well, the atomic film usually appears thickened. The chromatin of HCL has an in part condensed appearance that is halfway between an adult lymphocyte and a blast. Also, the chromatin has a uniform granular appearance in contrast to the unpredictably clustered chromatin of different disorders, especially B-cell incessant lymphocytic leukemia (B-CLL) and splenic minimal zone lymphoma (SMZL). Bushy cells have no obvious nucleoli or a single nucleolus. Rarely, cells with two nucleoli are present. For the most part, patients demonstrate a transcendence of nucleolated or nonnucleolated cells. The nucleoli are almost always small, round, and without irregularities in form.
The morphological presentation of HCL in the fringe blood is variable. Some patients present with the presence of leukaemic fringe blood, including a moderate lymphocytosis composed of morphologically identifiable bristly cells. In different cases, the fringe blood smear is prominent just for monocytopenia or neutropenia, with scant to absent coursing bushy cells.