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

Figure 6

Composite CLL/SLL and T-PLL. Flow cytometry immunophenotype ((a) and (b)) of a bone marrow aspirate specimen. Panel (a) shows a prominent T-cell population (CD5+, CD19-) as well as a minor CD19+/CD5+ B-cell population that corresponds to CLL/SLL. Panel (b) shows that 46% of the analyzed bone marrow cells were CD4+/CD8+ corresponding to T-PLL, as detected in 25% of T-PLL cases. This lymphocyte population also expressed CD7 (bright and homogenous) and CD26, further supporting the diagnosis of T-PLL. FISH analysis ((c) and (d)): (c) FISH analysis with ATM (green) and TP53 (red) exhibits 2 red, 1 green signal pattern, indicating ATM gene deletion; (d) FISH analysis with a TCL1 break-apart probe exhibits 1 red, 1 green (split), and 1 yellow signal, indicating TCL1 rearrangement.

(a)

(b)

(c)

(d)