Hairy cell leukemia. Enzyme histochemical characterization, with special reference to splenic stromal changes.

Seven spleens and two peripheral blood specimens from eight patients with hairy cell leukemia were examined with enzyme cytochemical and histochemical methods. Hairy cells consistently exhibited acid phosphatase and tartrate-resistant acid phosphatase. However, nonspecific esterases characteristic of monocytes and histiocytes were consistently absent or very weak. beta-glucuronidase and cytoplasmic membrane-bound ATPase were positive in four cases, suggesting a possible relationship to the B-lymphocytic series. Fundamental splenic changes were accumulation of hairy cells and benign macrophages within the pulp cords, with resulting extreme expansion of the cords. Abnormally well developed ellipsoids were identified around the sheathed arteries within the cords. Sinuses, specifically delineated with the NASDA reaction, were atrophic and often destroyed. No cytogeneologic relationship was found between sinus endothelial cells and hairy cells. The pulp cords are the primary site of involvement of the spleen in hairy cell leukemia. A simultaneous proliferation of neoplastic cells, histiocytes and reticulum fibers accounts for the splenomegaly and clinical hypersplenism characteristic of the disease.