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Novel leukemic lymphoma with probable derivation from immature stage of natural killer (NK) lineage in an aged patient
Author(s) -
Kawano Seiji,
Tatsumi Eiji,
Yoneda Noriko,
Yamaguchi Nobuo,
Goji Junko,
Ito Hiroshi,
Nagai Tomoko,
Nishikori Masaru,
Okamura Akiharu,
Koiwai Osamu
Publication year - 1995
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2900130102
Subject(s) - cd5 , terminal deoxynucleotidyl transferase , biology , pathology , cd3 , gene rearrangement , microbiology and biotechnology , natural killer cell , cd8 , immunology , antigen , medicine , cytotoxic t cell , immunohistochemistry , genetics , gene , tunel assay , in vitro
A 66‐year‐old male patient was admitted with dyspnea; physical examination revealed petechiae and systemic lymphadenopathy. Laboratory findings showed leukemia. The blasts in the peripheral blood were negative for cytochemical myeloperoxidase, and had condensed nuclear chromatin with a nucleolus. The histological diagnosis of the biopsied neck lymph node was lymphoblastic lymphoma. The leukemia cells expressed CD2, CD6, CD7, CD13 low , CD56, β chain of IL‐2 receptor low (IL‐2Rβ), and HLA‐DR antigens, but not other pan‐T (CD5, CD3, CD4, and CD8); pan‐B (CD10, CD19, CD20, and CD24); natural killer (NK) (CD16, CD57); or myeloid (CD33) antigens. Electronmicroscopy revealed convoluted nuclei with conspicuous nucleoli and peripherally condensed heterochromatin. Membrane‐bound granules containing an electron dense matrix were observed in the cytoplasm, indicating the NK cell nature of the neoplastic cells. While terminal deoxynucleotidyl transferase (TdT) and cytoplasmic CD3 were not detected by immunofluorescence on fixed smears, Northern blot analysis revealed the gene expression of CD3σ, CD3ζ, and TdT. Gene rearrangement analysis revealed that the β, γ, and δ chains of T‐cell receptor (TCR) and immunoglobulin heavy chain (IgH) were of germline genotype. While the overall interpretation of the phenotype and genotype was difficult, the derivation of an immature stage of NK lineage was strongly suggested, based predominantly on the electronmicroscopic features. Despite initially successful chemotherapy, the patient died 14 months after initial presentation.