PMC4668954_01
Peripheral blood smear showing a leukoerythroblastic picture with severe thrombocytopenia (Wright stain x400). Inserts showing examples of the circulating lymphoma cells having blastic morphology; large in size with finely dispersed chromatin and prominent nucleoli with irregular nuclear contour (x1,000).
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A peripheral blood smear showed a leukoerythroblastic picture with several blast-like cells with fine chromatin and one or more prominent nucleoli (Fig. 1).
Bone marrow aspirate showing involvement of lymphoma cells with blastic morphology. Insert (bottom left) and arrow show cohesive clusters of lymphoma cells (Wright stain x1,000).
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Cohesive clusters of the abnormal cells were also noted (Fig. 2).
Flow cytometry analysis of bone marrow aspirate at presentation revealed ~18% abnormal T-cells (X gate, purple population) showing immunophenotypic aberrancy (brighter CD45, slight downregulation of CD3 and CD7 with partial loss of CD5 expression) compared with the normal T-cells (gate Y, green population) and expressing CD2, CD8, and TCR alphabeta. The abnormal T-cells are negative for precursor markers CD34, Tdt, and CD1a.
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Bone marrow biopsy showing interstitial infiltration by medium-to-large lymphoma cells, many with irregular nuclear contour (A; H&E x1,000). Immunostains of the marrow biopsy: the lymphoma cells are positive for CD3 (B), CD5 (C), CD2 (D), and CD8 (E) and negative for CD7 (F) and CD4 (G; x400).
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The immunostains confirmed that the remarkably increased T-cells were positive for CD2, CD3, CD5, and CD8 with loss of CD7 expression (Fig. 4) and negative for CD34, TDT, CD99, Granzyme B, and ALK1.
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