Ann Lab Med.  2013 May;33(3):196-199. 10.3343/alm.2013.33.3.196.

A Case of CD4+T-Cell Large Granular Lymphocytic Leukemia

• Kim J
• Park CJ
• Jang S
• Cho YU
• Park SH
• Seo EJ
• Chi HS
• Suh C

• KMID: 1781326
• DOI: http://doi.org/10.3343/alm.2013.33.3.196

Abstract

We report here a case of a 59-yr-old man with CD4+ T-cell large granular lymphocytic leukemia (T-LGL). Peripheral blood examination indicated leukocytosis (45x10(9) cells/L) that consisted of 34% neoplastic lymphoid cells. Other laboratory results indicated no specific abnormalities except for serum antinuclear antibody titer (1:640), glucose (1.39 g/L), and hemoglobin A1c (7.7%) levels. Computed tomography indicated multiple small enlarged lymph nodes (<1 cm in diameter) in both the axillary and inguinal areas, a cutaneous nodule (1.5 cm in diameter) in the left suboccipital area, and mild hepatosplenomegaly. Bone marrow examination revealed hypercellular marrow that consisted of 2.4% neoplastic lymphoid cells. The neoplastic lymphoid cells exhibited a medium size, irregularly shaped nuclei, a moderate amount of cytoplasm, and large granules in the cytoplasm. Immunohistochemical analysis indicated CD3+, CD4+, T-cell receptor betaF1+, granzyme B+, and TIA1+. Flow cytometric analysis of the neoplastic lymphoid cells revealed CD3+, cytoplasmic CD3+, CD4+, and CD7+. Cytogenetic analysis indicated an abnormal karyotype of 46,XY,inv(3)(p21q27),t(12;17)(q24.1;q21),del(13)(q14q22)[2]/46,XY[28]. The patient was diagnosed with CD4+ T-LGL and received chemotherapy (10.0 mg methotrexate). This is the second case of CD4+ T-LGL that has been reported in Korea.

Keyword

CD4+ T-LGL skin lesion; Leukocytosis

MeSH Terms

Antibodies, Antinuclear/analysis
Blood Glucose/analysis
Bone Marrow Cells/metabolism/pathology
Hemoglobin A, Glycosylated/metabolism
Humans
Immunohistochemistry
Immunophenotyping
Karyotyping
Leukemia, Large Granular Lymphocytic/*diagnosis/pathology/radiography
Lymph Nodes/pathology
Male
Middle Aged
Neoplastic Cells, Circulating/metabolism/pathology
Tomography, X-Ray Computed
Antibodies, Antinuclear
Blood Glucose
Hemoglobin A, Glycosylated

Figure

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  Fig. 1 Neoplastic lymphoid cells. (A) The neoplastic lymphoid cells with large cytoplasmic granules in the peripheral blood (Wright-Giemsa stain, ×1,000). (B) The neoplastic lymphoid cells in bone marrow aspirates with a medium, irregularly shaped nuclei, a moderate amount of cytoplasm, and large cytoplasmic granules (Wright-Giemsa stain, ×1,000).

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  Fig. 2 Immunophenotyping of neoplastic lymphoid cells in peripheral blood by flow cytometry. (A) Gating of neoplastic lymphoid cells with bright CD45 expression and low SSC, (B) CD4 positivity (96% among gated cells) and CD8 negativity, (C) surface CD3 positivity (95%), (D) cytoplasmic CD3 positivity (93%), and (E) CD7 positivity (73%).Abbreviations: SSC, side scatter characteristics; FSC, forward scatter characteristics.

• 

  Fig. 3 Immunohistochemical findings in the bone marrow biopsy. (A) CD3+, (B) CD4+, (C) CD8-, (D) T-cell receptor βF1+, and (E) granzyme B+ (immunohistochemical stain, ×400).

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