68-year-old Black male presented with leukocytosis (WBC 86k/ul) and moderate thrombocytopenia (48k/ul). The only find on physical examination was massive splenomegaly (24 × 17 × 11 cm on CT scan). A low power view of his peripheral smear is shown. There is marked RBC poikilocytosis. The WBC are predominantly medium to large-sized lymphocytes with abundant agranular cytoplasm. A few of these cells appear to have cytoplasmic blebing and prominent nucleoli.