Rapidly Fatal Leukemia Comprising Pleomorphic Large Granular Lymphocytes A Report of 2 Cases
Resource
Anal. Quant. Cytol. Histol., 35(4), 232-236
Journal
Anal. Quant. Cytol. Histol.
Journal Volume
35
Journal Issue
4
Pages
232-236
Date Issued
2013
Date
2013
Author(s)
Win, Khin Than
Hsieh, Yen-Chuan
Yang, Chun-Chieh
Chang, Sheng-Tsung
Su, Ying-Zhen
Tien, Hwei-Fang
Chuang, Shih-Sung
Abstract
BACKGROUND: Large granular lymphocytes (LGLs) are either cytotoxic T or natural killer (NK) cells exhibiting round nuclei and azurophilic cytoplasmic granules. Morphologically, neoplastic LGLs of T cell lineage (T-LGLLs) are usually indistinguishable from normal LGLs, while there is a wide morphological range of aggressive NK cell leukemia (ANKL).
CASES: We present 2 consecutive cases of leukemia comprising pleomorphic LGLs. One patient presented with drowsy consciousness and unstable hemodynamics. Her peripheral blood smear disclosed a significant number of LGLs with pleomorphic nuclei expressing CD2, CD56 and HLA-DR but not surface or cytoplasmic CD3 (cCD3). The second patient, previously healthy, presented with a sudden death. Her peripheral blood revealed LGLs ranging from round to pleomorphic nuclei with a CD2+ cCD3+ surface CD3 CD56+ phenotype and clonally rearranged T cell receptor gene. The findings of the first patient were consistent with ANKL and the second, T-LGLL. Both patients passed away shortly before treatment.
CONCLUSION: The 2 cases highlight the importance of a multidisciplinary approach in addition to cytological examination to reach accurate diagnoses of such rare leukemia cases.
Subjects
aggressive natural killer cell leukemia
large granular lymphocytic leukemia
leukemia, natural killer cell large granular lymphocytic
leukemia, T cell large granular lymphocytic
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