How is hairy cell leukemia (HCL) diagnosed?

Updated: Sep 16, 2018
  • Author: Emmanuel C Besa, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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The diagnosis of hairy cell leukemia (HCL) is based on the following [13] :

  • Morphological evidence of hairy cells
  • An HCL immunologic score of 3 or 4 based on CD11C, CD103, CD123, and CD25 expression
  • Trephine bone marrow biopsy and/or aspiration, which makes it possible to specify the degree of tumoral medullary infiltration and the presence of BRAF V600E somatic mutation 

International consensus guidelines recommend performing immunohistochemistry (IHC) or flow cytometry to establish a diagnosis of HCL and distinguish classic HCL from other histologically similar peripheral small B-cell lymphoid neoplasms. In addition to the BRAF V600E mutation, testing should include assays for CD19, CD20, CD5, CD10, CD11c, CD22, CD25, CD103, CD123, cyclin D1, and CD200. [15, 16, 17]

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