Case Reports in Hematology / 2018 / Article / Tab 1

Case Report

Transformation of T-Cell Acute Lymphoblastic Lymphoma to Peripheral T-Cell Lymphoma: A Report of Two Cases

Table 1

Patient 1 pathological findings, by site.

Site (days from original diagnosis)DiagnosisMorphologyIHC (T-cell population of interest)Flow (T-cell population of interest)Gene rearrangementsPeripheral blood CBC with 100-cell differential count (%)

Left iliac crest 0 daysT-cell ALLSmall- to medium-sized blast population comprising 95% of cells; marrow nearly 100% cellularPositive: TdT, beta F1 Negative: TCRγPositive: CD3, CD4/CD8 dual positive, CD2, CD5 (d), CD7, and TDT (d) Negative: CD1a, CD34, CD117TβA257WBCa18.7
TβB269Hemoglobinb10.5
TβC182.9, 190.84MCVc92.8
TγA190.94, 214.3Plateletsa211
TγB172.9Lymphocytes15
Atypical lymphocytes0
Blasts1
Left iliac crest 104 daysNo evidence of malignancyncnpncTβA256WBCa3.62
TβB126, 263.8Hemoglobinb10.8
TβC190.63MCVc92.8
TγAGermlinePlateletsa334
TγB172.4Lymphocytes37
Atypical lymphocytes0
Blasts0
Cerebrospinal fluid 120 daysT-cell ALLLarge granular lymphocyte-like cells with condensed chromatin, inconspicuous nucleoli, eccentric nuclei, and moderate pale blue cytoplasm with prominent azurophilic granulesnpPositive: CD3c, CD7, CD8, CD45 (b), CD4 equivocal Negative: CD3, TdT, CD34npWBCa2.44
Hemoglobinb9.5
MCVc88.3
Plateletsa104
Lymphocytes34.4
Atypical lymphocytes0
Blasts0
Right iliac crest 124 daysγδ PTCLAtypical lymphohistiocytic T-cell infiltrate with granulomas; large mononuclear lymphocytes with round to irregular nuclear contours and moderate eccentric light blue pale cytoplasm and cytoplasmic granulesPositive: CD2, CD3 (>50%), CD5, CD7 (f), CD8, CD56, perforin, TIA, CD4 (equivocal) Negative: TdT, CD117, CD68, CD34, CD1a, CD99, granzyme-B, CD30, CD57, CD25, ISH EBERPositive: CD3, CD3c, CD5, CD7, CD4 (d), CD8 (d), CD45 Negative: TdT, CD34, CD56TβA275WBCa2.56
TβB126, 258, 263.8Hemoglobinb8.7
TβC182.92, 190.63MCVc88.1
TγA214.13Plateletsa76
TγB172.48Lymphocytes28.9
Atypical lymphocytes0
Blasts0
Skin, right arm 125 daysγδ PTCLAtypical lymphoid cellsPositive: CD2, CD3, CD5, CD4, CD8, CD56, TIA, CD99 (d), granzyme-B, TCRγ Negative: CD7, TdT, CD34, CD1andnpWBCa2.61
Hemoglobinb9.8
MCVc87.9
Plateletsa98
Lymphocytes32.2
Atypical lymphocytes0
Blasts0
Skin, right flank 189 daysγδ PTCLAtypical lymphocytic infiltrate comprised of large pleomorphic with round to irregular nuclear contours and ample cytoplasm with prominent nucleoli and elevated N:C ratioPositive: CD3, CD4, CD8, TCRγ, CD56 Negative: TdT, Beta F1, CD20Positive: CD3, CD5, CD4/CD8 dual positive, CD45, CD56 Negative: CD7 (partial loss)npWBCa9.1
Hemoglobinb10.9
MCVc95.8
Plateletsa58
Lymphocytes8
Atypical lymphocytes0
Blast0

Note: (b) bright; (d) dim; (f) focal; (s) positive in subset. +/− equivocal; nc, noncontributory; nd, nondiagnostic due to insufficient specimen; np, not performed. aIn k/μL; bin g/dL; cin fL. Manual differential used when available; otherwise, automated impedance counts were utilized.