Case Reports in Hematology / 2018 / Article / Tab 2

Case Report

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)DiagnosisMorphologyIHC (T-cell population of interest)Flow (T-cell population of interest)Gene rearrangementsPeripheral blood CBC with 100-cell differential count (%)Cytogenetics

5/2009Mediastinal massT-cell ALLMonotonous population of immature lymphoid cells with high N:C ratio, round to oval nuclei, mild nuclear irregularity, and scant cytoplasmPositive: TdT (90%)Positive: CD2, CD3, CD5 (d), CD7, CD4, CD8, CD45, CD10 Negative: CD20, EpCAM, CytokeratinTβAGermlineWBCa6.4
TβBGermlineHemoglobinb12.8
TβCGermlineMCVc87.2
TγAGermlinePlateletsa209
TγB185.23, 193.82Lymphocytes18.7
Atypical lymphocytes0
Blasts0
Pleural fluid 17 daysT-cell ALLImmature lymphoid blastsPositive: CD3, CD4, CD8, TdT, CD99 Negative: CD79anpnpncNo mitotic activity
Right iliac crest 18 daysT-cell ALLSheets of lymphoblasts with high N:C ratio, immature chromatin, visible nucleoli, scant cytoplasm with occasional cytoplasmic vacuolesnpPositive: CD45 (d), cyCD3, CD7, CD4, CD8, TdT (d), CD117, CD10 Negative: CD20, CD34; loss of surface CD3 and CD5npWBCa9.94
Hemoglobinb13.9
MCVc86.2
Plateletsa262
LymphocytesFew
Atypical lymphocytes22
Blasts0
9/2009Left iliac crest 131 daysNormocellular marrow with NEMncncncGermlinencNormal
3/2013Right iliac crest 1417 daysNormocellular marrow with NEMncnpncTβA262.3WBCa6.39
TβB261.10, 266.54Hemoglobinb1.7
TβC188.74MCVc90.6
TγAGermlinePlateletsa165
TγB174.32Lymphocytes19.7
Atypical lymphocytes0
Blasts0
Pleural fluid 1419 daysPTCL, NOS with 75% large T-cellsAbundant 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 granulesnpPositive: CD3c, CD8, CD45 Negative: CD3, CD7, CD4, TdT, CD117, CD20, CD34, CD56TβA259.6 (+/−)WBCa6.12SNP ARRAY
TβB252.79, 272.24Hemoglobinb10.4
TβC326.3MCVc91.5
TγA208.3, 216.77Plateletsa190
TγBGermlineLymphocytes19.6
Atypical lymphocytes0
Blasts0
3/2013Left chest wall mass 1419 daysPTCL, NOSSkeletal 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 nucleoliPositive: CD2, CD3, CD8 (b), ki67 (80%) Negative: CD5, CD7, CD4, TdT, CD15, CD20, CD30, CD34, CD56, pan-keratin, PAX5, EBV-LMP, EBERnpnpnc
Left flank massPTCL, NOSLarge 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 granulesPositive: CD3 (b), granzyme-B Negative: CD5, TdT, CD20, CD30, CD34, ALK-1, CD1a, myeloperoxidase, EBER ISHNot 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.