الفهرس 
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Abstract
CLL is a common B-lymphoproliferative disorder, which can be diagnosed in most cases by morphology and flowcytometry. It displays heterogeneity in clinical presentation, course, and response to treatment, which is likely due to the diversity of the biological nature of the disease. Diagnostic difficulty might arise in some patients due to atypical morphology and/or immunophenotype. CD73 is an extracellular enzyme that hydrolyses adenosine monophosphate to adenosine and is expressed on a subset of T and B lymphocytes. A number of studies have shown CD73 as a contributing factor in the multistep process of carcinogenesis by inducing favorable environment for tumor growth. However, it was shown in some studies to induce apoptosis. This is prospective study included 60 participant. All subjects were selected from the attendants the Clinical pathology and Internal Medicine Department , Tanta University, Informed consent was obtained from all participants before starting the research. The study design was approved by Tanta Faculty of Medicine’s Ethics Committee. The study population was divided into two groups: group I: (Study group): consisted of 30 diagnosed CLL patients by laboratory investigations or presented with fatigue and fever ± lymphadenopathy ± organomegaly. Before starting chemotherapy group II: (Control group): consisted of 30 apperently health, who matched the study group concerning age, sex, and socio-economic level. • The following were carried out for each subject: Complete history and clinical examination. Abdominal and chest CT scan for detection of internal organs or lymph node involvement. Immunophenotypic scoring system was obtained to differentiate CLL cases from other lymphoproliferative disorders. Laboratory investigations which include: a. Complete blood picture and blood film. c. Estimation of β2 microglobulin. d. Flowcytometric detection of CD73 and CD19 in peripheral blood. Regarding socio-demographic (age, sex, residence), there was no significant difference. As regard the comorbidities, In CLL patients group, 12 (40%) patients had hypertension, 12 (40%) patients were diabetic and 9 (30%) patients had dyslipidemia while in control group,10 (33.3%) patients had hypertension, 14 (46.7%) patients were diabetic and 5 (16.7%) patients had dyslipidemia. Regarding clinical data, out of the studied CLL patients, 14 (46.7%) patients presented with lymphadenopathy, 14 (46.7%) patients presented with splenomegaly and 12 (40%) patients presented with hepatomegaly. With reference to distribution of stages in CLL patients, the present study reported that 8 (26.7%) patients presented with stage 1 & III, 11 (36.7%) patients presented with stage II and 3 (10%) patients presented with stage VI. Regarding comparison between the studied groups regarding laboratory data, It was found that the mean hemoglobin level and platelets count were significantly lower in CLL patients group compared to control • group. while B2 microglobulin was significantly higher in CLL patients group compared to control group. With reference to comparison between the studied groups regarding CD19/CD73 expression, It was found that the CD19/CD73 expression was significantly lower in CLL patients group compared to control group. Concerning Correlations between CD19/CD73 expression and laboratory data in the study groups, It was found that CD19/CD73 expression had no significant correlation hemoglobin neither in CLL patients group nor control group. While, the CD19/CD73 expression had positive significant correlation with B2 microglobulin in CLL patients group while there was no correlation in control group. According Validity of CD19/CD73 expression in diagnosis of CLL, CD19/CD73 expression can diagnose CLL with high accuracy (100%) at cut-off point at 16.8. The sensitivity, specificity, PPV and NPV was 100%, 100%, 100% and 100% respectively.