title: T-cell prolymphocytic leukemia (T-PLL) with overlapping cytomorphological features with T-CLL and T-ALL: a case initially diagnosed by fine-needle aspiration cytology and immunocytochemistry.
abstract: T-cell prolymphocytic leukemia (T-PLL) is a very unusual form of chronic lymphoproliferative disorder, which has rarely been diagnosed by fine needle aspiration (FNA) cytology. We report one such case with some overlapping cytomorphological features with chronic lymphocytic leukemia and acute lymphoblastic leukemia. A 91-year-old man presented with generalized lymphadenopathy, pleural effusion, ascites, and an ulcerated growth in rectum. FNA smears from the left cervical lymph node showed a monotonous population of small lymphoid cells having small but distinct nucleoli that was initially diagnosed as chronic lymphocytic leukemia (CLL). Smears from the left axillary lymph node contained both small and medium-sized lymphoid cells with frequent hand-mirror cell appearance, which has been described in acute lymphoblatic leukemia (ALL). Immunocyto/histochemical stainings on smears and cell block preparations of the aspirate showed the following immunophenotype: CD3+, CD4+, CD5+, CD7+, CD8-, CD20-, CD23-, and Tdt-. Total peripheral blood leukocyte count was 26.4 × 10(9) /L and total lymphocyte count, 8.3 × 10(9) /L with predominance of small lymphocytes. T-cell nature of the neoplasm was confirmed by biopsies from the cervical lymph node (T-cell lymphoma), bone marrow (T-cell lymphoid neoplasm/chronic lymphocytic leukemia), and the ulcerated rectal lesion (atypical T-cell lymphoproliferative disorder). The patient developed deep vein thrombosis, heparin-induced thrombocytopenia and bleeding from duodenal ulcer. By the time the reports of all the investigations were ready, the patient succumbed to bronchopneumonia. To the best of our knowledge, this T-CLL/T-PLL which was diagnosed initially by FNA cytology with immunocytochemical support is first of its kind to be reported.
authors: Department of Pathology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait; Cytology Unit, Mubarak Al-Kabeer Hospital, Hawalli area, Jabriya, Kuwait. dilip76@hotmail.com
authors: Dilip K
authors: DK
authors: Das
authors: Shahed K
authors: SK
authors: Pathan
authors: Munish
authors: M
authors: Joneja
authors: Fatma A
authors: FA
authors: Al-Musawi
authors: Bency
authors: B
authors: John
authors: Kamran R
authors: KR
authors: Mirza
mesh_terms: D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001996:Bronchopneumonia / Q000473:pathology; D002466:Cell Nucleolus / Q000473:pathology; D002843:Chromatin / Q000473:pathology; D017809:Fatal Outcome; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D015461:Leukemia, Prolymphocytic, T-Cell / Q000175:diagnosis*; D015458:Leukemia, T-Cell / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology*; D013909:Thorax / Q000473:pathology; D013927:Thrombosis / Q000188:drug therapy
chemical_list: D002843:Chromatin; D006493:Heparin