Monthly Cell Challenge #2 / 2024
47 year old with abnormal lymphocytes
Description:
A 47-year-old male with cough, fever, unexpected weight loss, pain, and generalized lymphadenopathy was seen by his primary caregiver. Routine labs were ordered.
CBC results:
| Test | Result | Units |
| WBC | 9.3 | x109/L |
| HGB | 9.5 | g/dL |
| MCV | 84.9 | fL |
| PLT | 43 | x109/L |
Atypical Lympho? flag triggered blood smear analysis on Cellavision DC-1
| WBC Differential | % | x109/L |
| Neutrophils | 24.1 | 2.2 |
| Lymphocytes | 5.4 | 0.5 |
| Abnormal Lymphocytes | 60.7 | 5.6 |
| Eosinophils | 9.8 | 0.9 |
The abnormal lymphocytes displayed marked variation in size and high N:C ratios. Chromatin pattern was condensed. Most cells exhibited nuclear shape irregularities (notched/clefted, folded).
The patient was also found to have an elevated LDH, bilirubin, and was EBV+.
Immunophenotype: CD2+, CD3+, CD5+, variable CD7+, CD4- and CD8-.
Molecular testing revealed clonal rearrangement of T-cell receptor (TCR) genes.
Diagnosis
Peripheral T-cell lymphoma, NOS; a rare, aggressive malignancy with a 5-year survival of < 30%.*
Normal lymphocytes and small lymphoma cells in this case shared morphological characteristics. A side-by-side comparison of these cells assisted the user in separating them.
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*Pu, Q., et al. (2022). Differential diagnosis and identification of prognostic markers for peripheral T-cell lymphoma subtypes based on flow cytometry immunophenotype profiles. Frontiers in Immunology, 13, 1008695–1008695.