Composite Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and T-Prolymphocytic Leukemia Presenting with Lymphocytosis, Skin Lesions, and Generalized Lymphadenopathy

Figure 4

T-PLL in bone marrow biopsy specimen. A bone marrow clot section shows multiple lymphoid aggregates (white circle) composed predominantly of small-to-intermediate-size lymphocytes ((a), low power, (b), high power). The B-cell marker CD20 highlights scattered small lymphocytes (c). The T-cell marker CD3 highlights most lymphocytes in the lymphoid aggregates (d, e). Bone marrow aspirate smear shows numerous small-to-intermediate-size lymphocytes with scant cytoplasm displaying small projections and central nuclei with distinct nucleoli (f). The spectrum of T-PLL lymphocytes in the peripheral blood is shown (g); lymphocytes are predominantly small to intermediate in size with oval to slightly irregular nuclei and distinct nucleoli. The cell contours show blebs, while the cytoplasm is bluish and eccentric. Similar peripheral blood features were noted at initial presentation 3 years before.

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