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October 3, 1977

Hairy Cell Leukemia With Chylous Ascites

JAMA. 1977;238(14):1541-1542. doi:10.1001/jama.1977.03280150111044

HAIRY cell leukemia, or leukemic reticuloendotheliosis, is a rare chronic leukemia in which the bone marrow, liver, spleen, and abdominal lymph nodes are infiltrated by unique mononuclear cells with long cytoplasmic projections. Although retroperitoneal lymphadenopathy in the absence of noticeable peripheral lymphadenopathy is common in this disorder, to our knowledge, chylous ascites has not been previously reported. We describe a patient with hairy cell leukemia in whom chylous ascites were successfully treated with radiation therapy after several chemotherapy regimens failed.

Report of a Case  A 41-year-old man was referred because of ascites. Sixteen months earlier he was examined elsewhere for weight loss, night sweats, and splenomegaly. Hairy cell leukemia was diagnosed from blood smears and a bone marrow aspirate, and after a splenectomy, the patient became symptom-free. Three months prior to referral abdominal swelling developed. The patient then required paracentesis of several liters of milky, sometimes slightly pink fluid every