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.

The diagnosis of primary thyroid lymphoma by fine‐needle aspiration, cell block, and immunohistochemistry technique

“…We found that the diagnostic accuracy for PTL of FNA, CB of smears and the joint application of the three methods (FNA + CB + IHC) was 68.4%, 83.3%, and 100%, respectively (Table 3). In the eight reviewed studies which provided FNA, CB, and IHC results of lymphoma 16,[31][32][33][34][35][36][37] (Table 4). Volmar et al 36 and Ng et al 37 reported that the cytologic diagnosis can be confirmed further with proper application of immunostaining to CB sections.…”

“…In the eight reviewed studies which provided FNA, CB, and IHC results of lymphoma 16,[31][32][33][34][35][36][37] (Table 4). Volmar et al 36 and Ng et al 37 reported that the cytologic diagnosis can be confirmed further with proper application of immunostaining to CB sections. Zhang et al 16 showed the value of FNA and CBs in the diagnosis and classification of lymphoma of 177 cases was 99.0% of sensitivity, 95.9% of specificity, 97.1% of positive predictive value, and 98.6% of negative predictive value.…”

Management of cytologic material, preanalytic procedures and biobanking in lymph node cytopathology

“…More recently, CB has been successfully used, together with other technical devices in a large series of LN‐FNC of mantle cell lymphoma for SOX11 evaluation, showing a strong positivity in all cases and correspondence to the histologic controls . Das et al used different series of antibodies on CB to differentiate T‐cell prolymphocytic leukaemia with overlapping cytomorphological features from T‐cell chronic lymphocytic leukemia and acute lymphocytic leukemia (T‐CLL and T‐ALL). Lynnhtun et al performed a similar study on unclassifiable, B‐cell NHL, with intermediate features between DLBCL and HL.…”

Contribution of immunocytochemistry to the diagnosis of usual and unusual lymphoma cases

“…[ 14 15 ] In a report on a rare case of T-PLL by Das et al . [ 16 ] FNA smears from cervical lymph node showed a monomorphic population of small lymphoid cells with a frequent hand-mirror cell configuration, coarse chromatin, and small but distinct nucleoli; immunocytochemically the lymphoid cells were CD3+, CD4+, CD5+, CD7+, CD8‒, CD20‒, CD23‒, and Tdt‒ [ Figure 2 ].…”