CD23-negative atypical chronic lymphocytic leukemia with a novel three-way translocation t(4;10;13), unmutated: immunoglobulin heavy chain variable gene, and stereotyped subset #6 (case report).
- 1Laboratory of Research and Medical Analysis of the Royal Gendarmerie, Avenue Ibn Sina, Agdal, Rabat 10100, Morocco.
- 2Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
- 3Mohammed V Military Teaching Hospital, Rabat, Morocco.
Abstract
Chronic lymphocytic leukemia (CLL) is defined by the clonal expansion of mature B lymphocytes co-expressing CD19, CD5, and CD23. CD23 negativity is uncommon and creates real diagnostic difficulty, mainly because it overlaps with the mantle cell lymphoma (MCL) phenotype. We report a 55-year-old man who presented with massive lymphocytosis (595,000/mm3) and bilateral lymphadenopathy. Immunophenotyping showed a CD19+/CD5+/CD23- B-cell clone with a Matutes score of 4, establishing CLL diagnosis. Conventional karyotyping revealed a previously unreported three-way translocation t(4;10;13) (q32;q23;q14) alongside del(8)(q12q21) in 14 of 15 metaphases; FISH excluded TP53 deletion. Molecular analysis confirmed unmutated IGHV (100% germline homology) and stereotyped subset #6; two independent markers of poor prognosis that together signal constitutively active B-cell receptor signaling and antigen-driven disease progression. The patient sustained a traumatic brain injury shortly after diagnosis and died of refractory septic shock before CLL-directed therapy could begin. This case illustrates how adverse biological features can converge in the absence of TP53 disruption, and why full characterization, including immunophenotyping, metaphase cytogenetics, FISH, and molecular sequencing, is necessary to capture the true risk profile of the disease.
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BibTeX
@article{guaouguaou2026cd23negative,
title = {{CD23-negative atypical chronic lymphocytic leukemia with a novel three-way translocation t(4;10;13), unmutated: immunoglobulin heavy chain variable gene, and stereotyped subset #6 (case report).}},
author = {Rachida Guaouguaou and Amine Jebbor and Khalil Lotfi and Seloua Imane Ziani},
journal = {The Pan African medical journal},
year = {2026},
month = jun,
doi = {10.11604/pamj.2026.54.40.53226},
url = {https://europepmc.org/article/MED/42953034},
note = {CC BY},
}
RIS
TY - JOUR
TI - CD23-negative atypical chronic lymphocytic leukemia with a novel three-way translocation t(4;10;13), unmutated: immunoglobulin heavy chain variable gene, and stereotyped subset #6 (case report).
AU - Rachida Guaouguaou
AU - Amine Jebbor
AU - Khalil Lotfi
AU - Seloua Imane Ziani
PY - 2026
DA - 2026/06/10
JO - The Pan African medical journal
DO - 10.11604/pamj.2026.54.40.53226
UR - https://europepmc.org/article/MED/42953034
AB - Chronic lymphocytic leukemia (CLL) is defined by the clonal expansion of mature B lymphocytes co-expressing CD19, CD5, and CD23. CD23 negativity is uncommon and creates real diagnostic difficulty, mainly because it overlaps with the mantle cell lymphoma (MCL) phenotype. We report a 55-year-old man who presented with massive lymphocytosis (595,000/mm3) and bilateral lymphadenopathy. Immunophenotyping showed a CD19+/CD5+/CD23- B-cell clone with a Matutes score of 4, establishing CLL diagnosis. Conventional karyotyping revealed a previously unreported three-way translocation t(4;10;13) (q32;q23;q14) alongside del(8)(q12q21) in 14 of 15 metaphases; FISH excluded TP53 deletion. Molecular analysis confirmed unmutated IGHV (100% germline homology) and stereotyped subset #6; two independent markers of poor prognosis that together signal constitutively active B-cell receptor signaling and antigen-driven disease progression. The patient sustained a traumatic brain injury shortly after diagnosis and died of refractory septic shock before CLL-directed therapy could begin. This case illustrates how adverse biological features can converge in the absence of TP53 disruption, and why full characterization, including immunophenotyping, metaphase cytogenetics, FISH, and molecular sequencing, is necessary to capture the true risk profile of the disease.
SN - 1937-8688
ER -