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

Table 2

Patient 2 pathological findings, by site.

	Site (days from original diagnosis)	Diagnosis	Morphology	IHC (T-cell population of interest)	Flow (T-cell population of interest)	Gene rearrangements		Peripheral blood CBC with 100-cell differential count (%)		Cytogenetics
5/2009	Mediastinal mass	T-cell ALL	Monotonous population of immature lymphoid cells with high N:C ratio, round to oval nuclei, mild nuclear irregularity, and scant cytoplasm	Positive: TdT (90%)	Positive: CD2, CD3, CD5 (d), CD7, CD4, CD8, CD45, CD10 Negative: CD20, EpCAM, Cytokeratin	TβA	Germline	WBC^a	6.4
						TβB	Germline	Hemoglobin^b	12.8
						TβC	Germline	MCV^c	87.2
						TγA	Germline	Platelets^a	209
						TγB	185.23, 193.82	Lymphocytes	18.7
								Atypical lymphocytes	0
								Blasts	0
	Pleural fluid 17 days	T-cell ALL	Immature lymphoid blasts	Positive: CD3, CD4, CD8, TdT, CD99 Negative: CD79a	np	np		nc		No mitotic activity
	Right iliac crest 18 days	T-cell ALL	Sheets of lymphoblasts with high N:C ratio, immature chromatin, visible nucleoli, scant cytoplasm with occasional cytoplasmic vacuoles	np	Positive: CD45 (d), cyCD3, CD7, CD4, CD8, TdT (d), CD117, CD10 Negative: CD20, CD34; loss of surface CD3 and CD5	np		WBC^a	9.94
								Hemoglobin^b	13.9
								MCV^c	86.2
								Platelets^a	262
								Lymphocytes	Few
								Atypical lymphocytes	22
								Blasts	0
9/2009	Left iliac crest 131 days	Normocellular marrow with NEM	nc	nc	nc	Germline		nc		Normal
3/2013	Right iliac crest^† 1417 days	Normocellular marrow with NEM	nc	np	nc	TβA	262.3	WBC^a	6.39
						TβB	261.10, 266.54	Hemoglobin^b	1.7
						TβC	188.74	MCV^c	90.6
						TγA	Germline	Platelets^a	165
						TγB	174.32	Lymphocytes	19.7
								Atypical lymphocytes	0
								Blasts	0
	Pleural fluid 1419 days	PTCL, NOS with 75% large T-cells	Abundant large lymphoid cells with condensed chromatin, markedly irregular nuclear contours, frequent horseshoe-shaped nuclei, occasional binucleation, inconspicuous nucleoli, moderate-to-abundant pale blue cytoplasm, and cytoplasmic azurophilic granules	np	Positive: CD3c, CD8, CD45 Negative: CD3, CD7, CD4, TdT, CD117, CD20, CD34, CD56	TβA	259.6 (+/−)	WBC^a	6.12	SNP ARRAY
						TβB	252.79, 272.24	Hemoglobin^b	10.4
						TβC	326.3	MCV^c	91.5
						TγA	208.3, 216.77	Platelets^a	190
						TγB	Germline	Lymphocytes	19.6
								Atypical lymphocytes	0
								Blasts	0
3/2013	Left chest wall mass 1419 days	PTCL, NOS	Skeletal muscle extensively involved by a diffuse infiltrate of large lymphoid cells with granular chromatin, marked nuclear pleomorphism, markedly irregular nuclear contours, occasional horseshoe-shaped nuclei, and occasional conspicuous nucleoli	Positive: CD2, CD3, CD8 (b), ki67 (80%) Negative: CD5, CD7, CD4, TdT, CD15, CD20, CD30, CD34, CD56, pan-keratin, PAX5, EBV-LMP, EBER	np	np		nc
	Left flank mass	PTCL, NOS	Large lymphoid cells with granular chromatin, marked nuclear pleomorphism, markedly irregular nuclear contours, occasional horseshoe-shaped nuclei, occasional conspicuous nucleoli, moderate pale eosinophilic cytoplasm, and abundant cytotoxic granules	Positive: CD3 (b), granzyme-B Negative: CD5, TdT, CD20, CD30, CD34, ALK-1, CD1a, myeloperoxidase, EBER ISH	Not representative

Note: (b) bright; (d) dim; (f) focal; (s) positive in subset; +/− equivocal. NEM, no evidence of malignancy; 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. ^†The IHC profile is from a chest wall mass biopsy taken on the same day. This biopsy had a dense atypical lymphocytic infiltrate. Flow photocytometry demonstrated a 5% population of small T-cells. Limited material hindered full evaluation.