Rare Clinical Symptoms in Hairy Cell Leukemia: An Overview

Abstract

Background: Hairy cell leukemia (HCL) is a rare indolent B-cell lymphoid malignancy. The majority of patients are asymptomatic and HCL is usually diagnosed incidentally during a routine blood cell count. In symptomatic patients, typical symptoms are related to pancytopenia and splenomegaly. In this review, we present rare clinical symptoms in patients with HCL.

Methods: A literature search was conducted of PubMed, Web of Science and Google Scholar for articles concerning hairy cell leukemia, leukemia cutis, bone lesions, neurological manifestations, pulmonary symptoms, ocular manifestations, cardiac manifestation and rare symptoms. Publications from January 1980 to August 2024 were scrutinized. Additional relevant publications were obtained by reviewing the references from the chosen articles.

Results: Extramedullary and extranodal manifestations of classic HCL are rare. However, leukemic involvement in the skin, bone, central nervous system, gastrointestinal tract, heart, kidney, liver, lung, ocular system and other organs have been reported.

Keywords: bone lesions; cardiac manifestation; hairy cell leukemia; leukemia cutis; neurological manifestations; ocular manifestations; pulmonary involvement; pulmonary symptoms; rare symptoms.

Figure 1

Representative images of hairy cell leukemia bone lesions. Pathologic FDG uptake in the ribs, left humerus, vertebral body Th10, sacrum, right iliac, pubic bone and ischium imaged in PET/CT imaging (A). Mixed osteolytic and osteoblastic lesions in the sacrum in PET/CT imaging (B) and vertebrum in PET/CT imaging (C). Bone marrow infiltrate of HCL in Haematoxyllin and Eosin staining, magnification of 100× (D) and in staining for CD20, magnification of 100× (E).

Figure 2

Pulmonary involvement of HCL. X-ray chest PA view shows unilateral right diffuse pulmonary infiltrates (A). High-resolution computed tomography reveals septal thickening and multiple small and diffusely-merging focal consolidations with ground glass opacities in frontal (B), side (C) and transversal projection (D). Lung biopsy showing an infiltrate of HCL in Haematoxyllin and Eosin staining, magnification of 100× (E) and in staining for CD20, magnification of 100× (F). Damage or introduction of infection.