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T‐cell lymphoma associated with natural killer‐like T‐cell reaction
Author(s) -
Sun Tsieh,
Susin Myron,
Brody Judith,
Tack Kevin,
Marsh Jonathan,
Teichberg Saul,
Koduru Prasad,
Schwartz Paula
Publication year - 1998
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/(sici)1096-8652(199804)57:4<331::aid-ajh11>3.0.co;2-b
Subject(s) - natural killer cell , lymphoma , biology , pathology , t cell lymphoma , population , interleukin 21 , t cell , cell , cd30 , flow cytometry , bone marrow , immunology , cancer research , cytotoxic t cell , medicine , immune system , biochemistry , environmental health , in vitro , genetics
We report a case of T‐cell lymphoma showing in the peripheral blood (PB) exclusively T‐lymphocytes with suppresser T‐cell preponderance and a high percentage of natural killer (NK) marker positive cells by flow cytometry. A T‐cell receptor (TCR) gene analysis of the PB leukocytes demonstrated rearrangements of TCRα, TCRβ, and TCRγ genes. Therefore, the phenotype and genotype appeared to be consistent with an NK‐like T‐cell leukemia/lymphoma. However, when the PB lymphocytes were separated by size, it was found that 80% of NK marker positive cells were in the smaller cell population, while the neoplastic cells were in the large cell gate. A diagnosis of T‐cell lymphoma with reactive NK‐like T‐cells was finally confirmed by demonstrating the presence of both large atypical lymphoid cells and large granular lymphocytes (LGL) on PB smears. Although immunoperoxidase stain of bone marrow and colon showed positive T‐cell markers in the tumor cell population, cytoplasmic granules could not be identified in tissue sections and, thus, a distinction between T‐cell lymphoma and NK‐like T‐cell lymphoma could not be made by light microscopy until NK markers were studied. CD57 was demonstrated immunohistochemically in small lymphocytes but not in the large tumor cells in the colon. Electron microscopy, however, demonstrated LGL reaction to the lymphoma cells in the colonic biopsy. NK‐like T‐cell lymphoma usually carries a poorer prognosis than peripheral T‐cell lymphoma, thus the distinction of these neoplasms is important. This study emphasizes that T‐cell lymphoma may cause an LGL reaction or proliferation. If the lymphoma cells were of the same size as LGL, flow cytometric studies may have misled the diagnosis to NK‐like T‐cell‐lymphoma. Am. J. Hematol. 57:331–337, 1998. © 1998 Wiley‐Liss, Inc.