Hindawi Publishing Corporation Case Reports in Medicine Volume 2010, Article ID 136823, 2 pages doi:10.1155/2010/136823 Case Report Laparoscopic Splenectomy for Hairy Cell Leukemia in Pregnancy Beni Adegoke Adeniji,1 Moses Fallas,1 Marc Incerpi,2 Solomon Hamburg,1 Robert Katz,1 and Dotun Ogunyemi1 1 Cedars-Sinai Medical Center, 8700 W Beverly Bowerard, Los Angeles, CA 90048, USA 2 LAC+USC Medical Center, 1420 S Central Avenue, Glendale, CA 91201, USA Correspondence should be addressed to Dotun Ogunyemi, ogunyemid@cshs.org Received 21 April 2010; Accepted 18 August 2010 Academic Editor: William Hurd Copyright © 2010 Beni Adegoke Adeniji et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. We present a successful case of laparoscopic splenectomy for a massively enlarged spleen at 25 weeks of gestation for hairy cell leukemia in pregnancy in a woman with initial hemoglobin of 4.3 gm/dl and platelet count of 18,000/mm3. Study Design. Case report. Results. This report provides an approach to management that may be applicable in those cases where thrombocytopenia or other clinical imperatives preclude delaying treatment till after pregnancy. Conclusion. Hairy cell leukemia is a clonal B-Cell malignancy, for which there is very limited experience worldwide for its management when it occurs during pregnancy. Laparoscopic splenectomy should be considered as a therapeutic option, even with a signiﬁcantly enlarged spleen, in order to avoid the risks of fetal exposure to chemotherapeutic agents. Unique considerations relating to pregnancy are highlighted. 1. Introduction Hairy cell leukemia (HCL) is a chronic lymphoid leukemia recognized as a clonal B-cell malignancy. It presents with abnormal cells which have hairlike cytoplasmic projections on the surface (under light microscopy) by which the disease was named in 1966 by Schrek and Donnelly [1]. It is a rare form of leukemia, with an incidence rate of 0.33 per 100,000 person years in the United States [2]. The mean age at presentation is 52 years, with a male Caucasian preponderance. Historically treated by splenectomy and chemotherapy with single agent 2-chlorodeoxyadenosine (Cladribine, 2-CdA) being currently the preferred treatment because of its eﬃcacy whilst avoiding the risks of major surgery. HCL is even more uncommon in pregnancy, with a review of worldwide literature documenting only six (6) prior cases of HCL in pregnancy [3, 4]. 2. Case Report Our patient is a 37-year-old gravida 2 para 1 Caucasian female who presented at 23 weeks gestation with recur- rent epistaxis and ecchymosis of the soft palate. Clinical evaluation revealed pancytopenia and splenomegaly. On her initial blood count, white cell count was 900/mm3, hematocrit 13.7%, and platelet count, 18,000/mm3. Bone marrow biopsy was consistent with HCL, CD 20 positive, CD 68 positive, and DBA 44 positive. The spleen measured approximately 17 × 13 × 4.5 cm on abdominal sonography. The patient desired continuation of pregnancy and was unwilling to accept the risks of chemotherapy or interferon alpha treatment in pregnancy. Treatment with Prednisone (60 mg per day) was initiated but the hematologic indices deteriorated further. Following extensive multidisciplinary consultations, it was decided that laparoscopic splenec- tomy oﬀered the best potential for sustained improvement in hematologic indices whilst allowing the pregnancy to progress to viability with the least fetal risk. The patient was extensively counseled regarding the risks and beneﬁts in line with the guidelines for use of laparoscopy for surgical problems during pregnancy as recommended by the Soci- ety of American Gastrointestinal and Endosopic Surgeons (SAGES) [5]. She received the polyvalent pneumococcal vaccine prior to splenectomy. A laparoscopic splenectomy was performed at 25 weeks gestation. The patient was admitted one day before the