Which histologic findings are characteristic of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the prostate?

Updated: Dec 22, 2019
  • Author: Joshua I Warrick, MD; Chief Editor: Liang Cheng, MD  more...
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Answer

Answer

As in other sites, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the prostate histologically appears as expanses of monomorphic mature-appearing lymphocytes with round nuclear contours, condensed chromatin, and inconspicuous nucleoli. The infiltrate is usually patchy in distribution. Lymphoma cells may efface the prostate architecture and may extend outside of the prostate. Tumor cells typically infiltrate the prostatic stroma in a nonperiglandular manner, and they may infiltrate between normal prostate glands. The typical immunophenotype is CD20+/CD10-/CD5+/cyclin D1-. Light-chain restriction may be identifiable by immunohistochemistry.

The primary differential diagnosis of CLL/SLL is benign chronic inflammation, which is very common in the prostate. In contrast to the monomorphic, expansive infiltrate of CLL/SLL, benign chronic inflammation is composed of a heterogeneous inflammatory cell population, which tends to be more limited in extent than lymphoma. Benign chronic inflammation is also preferentially periglandular and, thus, it does not demonstrate the infiltrative growth in the prostatic stroma frequently observed in CLL/SLL.

See the images below.

Pathology of prostate leukemia and lymphoma. Chron Pathology of prostate leukemia and lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the prostate. Lymphoma cells infiltrate the prostatic stroma in a nonperiglandular manner.
Pathology of prostate leukemia and lymphoma. Chron Pathology of prostate leukemia and lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the prostate, high power. The lymphoid cells are monomorphic and low grade.
Pathology of prostate leukemia and lymphoma. Chron Pathology of prostate leukemia and lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) involving the prostate. Lymphoma cells infiltrate between the prostate glands, in a more subtle manner than in the case in the previous image. There was also CLL/SLL involvement of the pelvic lymph nodes in this patient.
Pathology of prostate leukemia and lymphoma. Chron Pathology of prostate leukemia and lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the prostate, high power. The lymphoma cells are monomorphic and low grade.

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