PMC3818024_01
Chest X-ray revealed a pleural effusion.
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The electrocardiogram was normal; the echocardiogram showed pericardial effusion and a chest X-ray revealed bilateral pleural effusion (Figure 1).
Scattergram of normal and T-ALL pleural fluid.. Note: Scattergram of (A) normal and (B) T-ALL pleural fluid.. Abbreviations: T-ALL, T-lineage acute lymphoblastic leukemia; DIFF, differentiated by flow cytometry; SFL, side fluorescence; SSC, side scatter cells.
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Cell cluster spreading from the MN area into the high-fluorescence area was observed (Figure 2A); this cell cluster had higher forward and side scatter than normal cells (Figure 2B), meaning that those cells were bigger and more complex. Cytospin preparation (CytoFuge2; IRIS International, Chatsworth, CA, USA) was performed with the pleural fluid using 250-300 muL of the cell suspension (20 cells/muL) to obtain a cell pellet of approximately 5,000 cells.
Digital images of blast cells from the pleural effusion, as presented on the digital analyzer.
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Morphological examination (Figure 3) of the pleural fluid revealed a massive infiltration of immature cells, with large and clefted nuclei; the cytoplasm was basophilic without granules, and was scant in volume, large in size, presenting with fine chromatin and evident nucleoli.
Flow cytometry analysis of the pleural fluid.. Notes: Blasts are shown in red, and lymphocytes are shown in blue. Blasts were CD45+/-, CD3-, CD7++, CD5+, CD2-, CD34+/-, CD1a-, CD3Cy+, and TdTCy+.. Abbreviations: SSC, side scatter cells; FITC, fluorescein isothiocyanate; CD3, surface CD3; CD3Cy, cytoplasmic CD3; TdTCy, cytoplasmic TdT.
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CA, USA). Cytograms (Figure 4) showed that the cells (in red; P1) were CD45+/-, CD3-, CD7++, CD5+, CD2-, CD34+/-, CD1a-, CD3Cy+, TdTCy+, which were immature T-lineage cells. Therefore, a bone marrow aspirate was performed (Figure 5), which showed an infiltration of lymphoblast cells. Flow cytometry analysis on peripheral blood and bone marrow (Figure 6) were also performed; according to the European Group for the Immunological Classification of Leukemia (EGIL) criteria, the malignancy was classified as Pro T-lineage acute lymphoblastic leukemia (T-ALL) (EGIL T1). Cytogenetic and fluorescence in situ hybridization analyses showed a normal karyotype.
Flow cytometry analysis of peripheral blood.. Notes: Blasts are shown in red, and lymphocytes are show in blue. Blasts were CD45+/-, CD3-, CD7++, CD34+/-, and CD3Cy+.. Abbreviations: SSC, side scatter cells; FITC, fluorescein isothiocyanate; CD3, surface CD3; CD3Cy, cytoplasmic CD3.
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CA, USA). Cytograms (Figure 4) showed that the cells (in red; P1) were CD45+/-, CD3-, CD7++, CD5+, CD2-, CD34+/-, CD1a-, CD3Cy+, TdTCy+, which were immature T-lineage cells. Therefore, a bone marrow aspirate was performed (Figure 5), which showed an infiltration of lymphoblast cells. Flow cytometry analysis on peripheral blood and bone marrow (Figure 6) were also performed; according to the European Group for the Immunological Classification of Leukemia (EGIL) criteria, the malignancy was classified as Pro T-lineage acute lymphoblastic leukemia (T-ALL) (EGIL T1). Cytogenetic and fluorescence in situ hybridization analyses showed a normal karyotype.
Digital image of bone marrow aspirate.
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CA, USA). Cytograms (Figure 4) showed that the cells (in red; P1) were CD45+/-, CD3-, CD7++, CD5+, CD2-, CD34+/-, CD1a-, CD3Cy+, TdTCy+, which were immature T-lineage cells. Therefore, a bone marrow aspirate was performed (Figure 5), which showed an infiltration of lymphoblast cells. Flow cytometry analysis on peripheral blood and bone marrow (Figure 6) were also performed; according to the European Group for the Immunological Classification of Leukemia (EGIL) criteria, the malignancy was classified as Pro T-lineage acute lymphoblastic leukemia (T-ALL) (EGIL T1). Cytogenetic and fluorescence in situ hybridization analyses showed a normal karyotype.