title: Floral leukemic cells transformed from marginal zone lymphoma.
abstract: There are three clinicopathological entities of marginal zone lymphoma (MZL), including extranodal or mucosa-associated lymphoid tissue (MALT) lymphoma and MZL of nodal (NMZL) or splenic (SMZL) type. Of these, leukemic presentation, usually as small or villous lymphocytes, is more common in SMZL, while leukemic change in NMZL is rare, and the morphology has not been characterized. We present a stage 4 MZL involving lymph node, spleen, and bone marrow with two relapses after chemotherapy. The leukemic cells at the second relapse revealed irregular nuclear contours with multilobated nuclei (so-called flower cells or floral cells) mimicking the neoplastic cells in adult T-cell leukemia/lymphoma (ATLL). The absence of leukemic change and splenic hilar lymphadenopathy at initial presentation, expression of IgD by tumor cells, and cytogenetic changes of +7 suggested that this tumor might be a NMZL. Although the cytomorphologic features of floral leukemic cells might suggest ATLL, thorough clinical and laboratory workup helped to reach a correct diagnosis. Our findings broaden the cytological spectra of leukemic cells in MZL and illustrate the importance of immunophenotyping.
authors.affiliation: Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Sheng-Tsung
authors.initials: ST
authors.lastname: Chang
authors.forename: Yen-Chuan
authors.initials: YC
authors.lastname: Hsieh
authors.forename: Yi-Hsuan
authors.initials: YH
authors.lastname: Lu
authors.forename: Ching-Cherng
authors.initials: CC
authors.lastname: Tzeng
authors.forename: Ching-Nan
authors.initials: CN
authors.lastname: Lin
authors.forename: Shih-Sung
authors.initials: SS
authors.lastname: Chuang
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001854:Bone Marrow Cells / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology; D003582:Cytogenetics; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007072:Immunoglobulin D / Q000032:analysis; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000175:diagnosis* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008214:Lymphocytes / Q000276:immunology / Q000473:pathology*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008297:Male; D011878:Radiotherapy; D012008:Recurrence; D013154:Spleen / Q000473:pathology*; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents; D007072:Immunoglobulin D