Hairy cell leukemia associated with carcinoma: report of two patients and review of the literature

Splenic metastasis in hairy cell leukemia

BACKGROUND

Splenic metastasis is uncommon and usually occurs in the setting of widespread visceral metastasis. Splenic metastasis as an initial manifestation of disease and sole site of metastasis has not been reported previously.

METHODS

The authors describe a patient with hairy cell leukemia (HCL) with the unexpected finding of metastatic adenocarcinoma in the spleen. Direct inspection at the time of laparotomy and subsequent radiographic studies did not show a primary or additional metastatic tumor. Eventually, he manifested evidence of pulmonary and hepatic metastases and died with fungal sepsis.

RESULTS

The splenectomy specimen showed HCL and metastatic adenocarcinoma. Immunohistochemical studies showed adenocarcinoma with diffuse cytoplasmic staining for prostate-specific antigen and focally positive results with prostatic acid phosphatase antigen. Postmortem examination 9 months later showed HCL and widespread metastatic adenocarcinoma. No primary tumor was identified, and multiple tissue blocks of the prostate had negative findings for tumor.

CONCLUSIONS

The immunohistologic features of the metastatic adenocarcinoma were interpreted as prostatic in origin. The pattern of isolated metastatic disease in the absence of primary tumor appears to represent another possible atypical disease presentation of prostatic cancer. Hairy cell-induced structural and immunologic alterations within the splenic microenvironment may have contributed to this unique clinical presentation.

Ki-1-positive lymphoma developing 10 years after the diagnosis of hairy cell leukemia

The case is described of a 62-year-old man with a 10-year history of hairy cell leukemia (HCL) who subsequently had a large-cell anaplastic or so-called Ki-1-positive lymphoma. Immunocytochemical staining of the lymphomatous node revealed positivity for Ki-1 (CD30) and epithelial membrane antigen in the tumor cells, and flow cytometric analysis showed simultaneous expression of Leu M5 (CD11c) and Leu 14 (CD22). Although HCL has been reported to coexist with both Hodgkin's disease and non-Hodgkin's lymphoma, the authors believe this is the first case in which a Ki-1-positive lymphoma developed in a patient with HCL. The clinicopathologic and immunologic features of both entities are discussed, as is the association of HCL with other neoplasms.