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Case 95 - Discussion

Hematopathology Case

Flow Cytometry

      CD3   Dim

      CD5   +

      CD8   +

      TdT   +

      CD1   Partial

 

 Immunohistochemistry stains:

      CD2   +

      CD5   +

      TdT   +

      CD20  -

 

T-Cell Lymphoblastic Lymphoma (T-LBL)

  • The patient had involvement of tumor cells in the bone marrow and peripheral blood.

  • Flow cytometry: low density for CD45, CD1a, CD3, CD4, CD5, CD8, CD34, CD38, and CD56. TdT is also positive.

  • Cytogenetics: hypodiploid with multiple genetic abnormalities

  • Discussion: the tumor cells are medium sized with round nuclei, moderately delicate chromatin and inconspicuous nucleoli. The cytoplasm is scant. There are three differential diagnoses of this so called "blastoid" morphology: Burkitt lymphoma, lymphoblastic lymphoma, and blastoid mantle cell lymphoma (typically in old patients). In contrast to B-cell acute lymphoblastic leukemia/lymphoblastic lymphoma (B-ALL/LBL), the T-ALL/LBL often presents as solid mass lesion in mediastinum, lymph node or other extranodal regions. Also need to rule out thymoma in adults.