An 81-year-old man presented with weight loss and lymphocytosis with a white blood cell count of 55,000/µL with 80% lymphocytosis and 20% segmented neutrophils. Hemoglobin was 14 g/dL and platelets 139 × 10³/µL. In flowcytometric analysis of peripheral blood, the CD19-expressing lymphocytes (52%) were positive for CD5, CD23, and CD200 and they were negative for CD10, CD103, CD25, and T-cell markers. There was no surface expression of light chains. Serum protein electrophoresis revealed mild hypogammaglobulinemia (0.60 g/dL, normal >0.69) and on immunofixation electrophoresis there was a small monoclonal spike of IgG Lambda.