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A few cases with hairy cell leukemia presented by isolated bone involvement were reported. Herein we report a case with hairy cell leukemia with isolated bone lesions. A 48-year-old male admitted to our hospital with a left knee pain for three years. Magnetic resonance imaging was performed during his previous complaints and did not reveal any pathological findings. Conventional X-Ray revealed a cystic infiltrative left tibia lesion. The computed tomography scan was normal except slight splenomegaly. The total body positron emission tomography scan revealed multiple pathologic involvements in bones. Bone marrow biopsy and aspiration morphology with flow cytometry were normal without any involvement. Thus, bone biopsy was performed from the tibia lesion. The morphology of the bone biopsy with the immunohistochemistry revealed typical features of hairy cell leukemia with strong CD20, CD25, annexin A1, faint cyclin D1 positivity and less than 5% proliferation indexes with Ki67. Molecular analysis with sanger sequencing revealed BRAF V600E mutation supporting hairy cell leukemia diagnosis. The patient was treated with cladribine, 7 days, 0.1 mg/kg and additional local radiotherapy. After 3 years, the patient is still on remission and had no progressive lesions. As a conclusion, we would like to take an attention for isolated bone involvement as a rare presentation and BRAF V600E mutation as a diagnostic tool in hairy cell leukemia patients.

Hairy Cell Leukemia Presenting with Isolated Bone Lesions