Liu YC, Margolskee E, Allan JN, et al. - Via a single-institution retrospective study, experts examined the clinicopathologic characteristics of chronic lymphocytic leukemia with TP53 alterations as well as the utility of various diagnostic modalities to recognize p53 alterations. Atypical lymphocytes with cleaved/irregularly shaped nuclei and/or large atypical lymphoid cells with abundant cytoplasm in the peripheral blood were expressed by 40% of chronic lymphocytic leukemia patients with TP53 alterations. In lymph node and bone marrow samples, progression was also recognized. Nevertheless, within the chronic lymphocytic leukemia group with TP53 abnormalities, the presence of the morphologic characteristics indicative of the “accelerated phase” had no impact on overall survival. As formerly reported by others, a subset of patients with TP53 alterations were only recognized by either PCR mutation analysis or cytogenetic studies. In nearly half of the patients with TP53 alterations recognized by either method, p53 immunostain positivity was only identified, and it failed to recognize any additional patients with p53 abnormalities. Atypical morphologic characteristics were often exhibited by chronic lymphocytic leukemia patients with TP53 alterations. The use of multiple modalities to recognize p53 abnormalities is suggested to guarantee optimal sensitivity and specificity.