Fragility of sub-cellular structures in chronic lymphocytic leukemia

Excerpt

Ferdinand Gumprecht first described degraded leukocytes associated with leukemia 120 years ago (Deutsches Archiv für klinische Medizin, Leipzig, 57: 523–548, 1896). We describe herein a unique blood film of a 64-year-old patient with chronic lymphocytic leukemia (CLL), which displays fragmentation of sub-cellular structures, some of which are associated with the formation of smudge (Gumprecht) cells. Intact CLL cells exhibit membrane protrusions infiltrated by chromatin (Fig. 1a, b, arrows). In some of these cells, the plasma membrane is breached, and the chromatin has spilled outside the cells (Fig. 1c–e, arrows), occasionally via multiple egresses (Fig. 1e, f, arrows). Chromatin extrusion is occasionally accompanied by the release of plasma membrane fragments (Fig. 1f, g, dashed arrows). Following the spread of extracellular chromatin, the empty membrane shell shrinks (Fig. 1d, e, h, arrowheads). In some cells, the color of the May-Grounwald/giemsa-stained chromatin turns from a nuclear-condensed purple to a reticulated pink spreading among erythrocytes (Fig. 1g, h, arrows), similar to that seen in smudge cells. Typical smudge cells contain only diffuse pink chromatin, with no other remnants (Fig. 1i).

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