Case Report: Incidental and Early Pathologic Detection of CLL After Bunionectomy
Posted: Wednesday, November 10, 2021
Mandated pathologic testing of all excised bone and tissue may provide early detection of pathologies such as chronic lymphocytic leukemia (CLL), according to Timothy Pal, MD, of the Veteran Affairs Medical Center (VAMC), Northport, New York, and colleagues. In this case study, a 72-year-old man without a history of cancer underwent surgical removal of a painful bunion, leading to an incidental CLL diagnosis. The findings of this study were published in The Journal of Foot and Ankle Surgery.
“This case presentation hopes to encourage practitioners to ponder the benefits of early detection. The unexpected identification of a neoplasm in such cases helps confirm the merit of the institutional and lab policies for examining all tissues for the patient population at the Northport VAMC,” stated the study investigators.
The patient presented with a primary complaint of chronic left foot pain. Prior distal metatarsal bunionectomy at another facility had not provided pain relief. At Northport VAMC, the patient underwent left foot modified McBride bunionectomy, Akin osteotomy, and second digit arthroplasty with metatarsal phalangeal joint capsule release. A preoperative complete blood cell count indicated slightly elevated levels of white blood cells and lymphocytes but no other blood abnormalities.
Postoperative processing and examination of the excised specimen revealed irregular fragments of bone, connective tissue, and skin but no evidence of a mass lesion. Histologic sections of the bone marrow indicated the presence of interstitial and paratrabecular lymphoid aggregates composed of small lymphocytes, positive for the CLL-associated proteins CD20, CD23, BCL2, and CD79. Subsequent peripheral blood flow cytometry confirmed CLL. Following oncologic evaluation and 1-year follow up, peripheral blood flow analysis led to a diagnosis of low-risk, stage 0, CD38-, ZAP70-, TP53-negative, and IGHV-mutated CLL, with a positive prognosis. The patient was asymptomatic, closely monitored, and had normal hemoglobin and platelet counts, so no additional treatment was recommended.
Disclosure: The study authors reported no conflicts of interest.
