#00065736

Figure 2: Flow cytometric immunophenotyping reveals a dim lambda-restricted monotypic B-cell population (~30% of the CD45+ cellular events) that is CD19+, dim CD20+, CD5+, CD43+, and CD81-.  Additionally, there is a dim CD45+ myeloblast population (~10% of the CD45+ cellular events) that is CD34+, dim CD117, CD33+, CD123+, dim HLA-DR, CD13-, CD7-, CD19-, CD64-, CD14-, and CD56-. Chromosome analysis revealed an abnormal male karyotype with a deletion of 13q in the small round cells, most likely associated with chronic lymphocytic leukemia (CLL). Two additional distinct clones were also identified, showing near-tetraploidy with a relative deletion of 5q and a gain of chromosome 13 in the larger cells, findings most consistent with a myeloid neoplasm. Next generation sequencing (NGS) showed mutations in DNMT3A, RUNX1 and SRSF2.