T-cell lymphoma associated with natural killer-like T-cell reaction

Tsieh Sun, Myron Susin, Judith Brody, Kevin Tack, Jonathan Marsh, Saul Teichberg, Prasad Koduru, Paula Schwartz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

We report a case of T-cell lymphoma showing in the peripheral blood (PB) exclusively T-lymphocytes with suppresser T-cell preponderance and s 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.

Original languageEnglish (US)
Pages (from-to)331-337
Number of pages7
JournalAmerican Journal of Hematology
Volume57
Issue number4
DOIs
StatePublished - Apr 1998

Keywords

  • Flow cytometry
  • Gene rearrangement
  • Immunohistochemistry
  • NK-like T-cell
  • T-cell lymphoma

ASJC Scopus subject areas

  • Hematology

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