title: Rapidly fatal leukemia comprising pleomorphic large granular lymphocytes: a report of 2 cases.
abstract: BACKGROUND
  Large granular lymphocytes (LGLs) are either cytotoxic T or natural killer (NK) cells exhibiting round nuclei and azurophilic cytoplasmic granules. Morphologically, neoplastic LGLs of T cell lineage (T-LGLLs) are usually indistinguishable from normal LGLs, while there is a wide morphological range of aggressive NK cell leukemia (ANKL).
  
  
  METHODS
  We present 2 consecutive cases of leukemia comprising pleomorphic LGLs. One patient presented with drowsy consciousness and unstable hemodynamics. Her peripheral blood smear disclosed a significant number of LGLs with pleomorphic nuclei expressing CD2, CD56 and HLA-DR but not surface or cytoplasmic CD3 (cCD3). The second patient, previously healthy, presented with a sudden death. Her peripheral blood revealed LGLs ranging from round to pleomorphic nuclei with a CD2+ cCD3+ surface CD3- CD56+ phenotype and clonally rearranged T cell receptor gene. The findings of the first patient were consistent with ANKL and the second, T-LGLL. Both patients passed away shortly before treatment.
  
  
  CONCLUSIONS
  The 2 cases highlight the importance of a multidisciplinary approach in addition to cytological examination to reach accurate diagnoses of such rare leukemia cases.
authors: Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.
authors: Khin Than
authors: KT
authors: Win
authors: Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.
authors: Yen-Chuan
authors: YC
authors: Hsieh
authors: Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors: Chun-Chieh
authors: CC
authors: Yang
authors: Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.
authors: Sheng-Tsung
authors: ST
authors: Chang
authors: Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.
authors: Ying-Zhen
authors: YZ
authors: Su
authors: Division of Hematology, Department of Internal Medicine, National Taiwan University.
authors: Hwei-Fang
authors: HF
authors: Tien
authors: Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.
authors: Shih-Sung
authors: SS
authors: Chuang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D019070:Cell Lineage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007694:Killer Cells, Natural / Q000473:pathology*; D054066:Leukemia, Large Granular Lymphocytic / Q000097:blood* / Q000473:pathology*; D013602:T-Lymphocytes, Cytotoxic / Q000473:pathology*
chemical_list: D015415:Biomarkers