A 61-year-old man was admitted to our department complaining a general malaise and visual disturbance of 7 months duration.
On physical examination, retinal bleeding and marked hepatosplenomegaly were noticed. No lymphadenopathy was noted.
Laboratory studies revealed white blood cell counts 12×104/cmm with 88% of abnormal lymphocytes.
These abnormal cells were about 15μ in diameter and had a pale blue gray cytoplasm with no projections on Wright-Giemsa stained films. The nucleus was large and oval with fine chromatin structure and one large prominent nucleolus.
Under electronmicroscopy, cytoplasm of the abnormal cell contained a few mitochondria which accumulated to one side of the cells and a few microvilli. Ribosomes were dispersed.
These leukemic cells were not stained by peroxidase, naphthol AS-D chloroacetate esterase, α-naphythyl acetate esterase, nor by PAS staining. Moreover, they were almost negative for acid phosphatase and had no resistance to L (+) tartaric acid. Murmidase activities in the serum and urine were within normal limits. No terminal deoxynucleotidyl transferase activity was detected in these leukemic cells.
Eighty seven per cent of the leukemic cells had monoclonal IgM-K type surface immunoglobulin which was demonstrated by the indirect immunofluorescence method, and forty per cent of the leukemic cells formed the EAC rosette.
