Journal List > Korean J Cytopathol > v.19(2) > 1006523

Korean J Cytopathol. 2008 Sep;19(2):168-172. English.
Published online September 30, 2008.  https://doi.org/10.3338/kjc.2008.19.2.168
Copyright © 2008 The Korean Society for Cytopathology
Cytologic Features of Ascitic Fluid Complicated by Small Cell Variant T-cell Prolymphocytic Leukemia -A Case Report-
Jee Young Han, M.D., Jin Soo Kim, M.D.,1 Dong Hoon Kim, M.D.,2 Lucia Kim, M.D., In Suh Park, M.D., Joon Mee Kim, M.D., Young Chae Chu, M.D. and Suk Jin Choi, M.D.
Department of Pathology, Inha University Hospital and College of Medicine, Incheon, Korea.
1Department of Hemato-oncology division in Department of Internal Medicine, Inha University Hospital and College of Medicine, Incheon, Korea.
2Department of Pathology, Dankook University Hospital, Cheonan, Korea.
Received July 17, 2008; Accepted August 29, 2008.

Abstract

T-cell prolymphocytic leukemia (T-PLL) is a rare, mature T-cell lymphoproliferative disorder with a post-thymic mature T-cell phenotype. The disease is characterized by rapidly rising lymphocytosis, lymphadenopathy, and splenomegaly. The clinical course is usually aggressive and progresses with frequent skin lesions and serous effusions. In 25% of cases, leukemic cells are small and tumor cells may not have a discrete nucleolus under light microscopy. Although the presence of characteristic cytoplasmic protrusions or blebs in tumor cells is a common morphologic finding in the peripheral blood film irrespective of the nuclear features, small cell variants lacking the typical nuclear features can cause diagnostic problems in clinical cytology. Furthermore, the small leukemic cells can share some cytologic findings with lymphocyte-rich serous effusions caused by non-neoplastic reactive lymphocytosis as well as other small lymphocytic lymphoproliferative disorders. Here, we describe the cytological findings of ascitic fluid complicated by small cell variant T-PLL in a 54-year-old man, the cytology of which was initially interpreted as small lymphocytic malignancy such as small lymphocytic lymphoma/chronic lymphocytic leukemia.

Keywords: Leukemia; Prolymphocytic; T-cell; Cytology; Ascitic fluid

Figures


 Fig. 1
Cytology of ascitic fluid: (A) The smear is moderately cellular with monomorphous population of small lymphocytes in clear background with a small number of reactive mesothelial cells. (B) Some lymphoid cells exhibit prominent nucleoli and asymmetrical cytoplasmic elongations. (Papanicolaou stain).
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Fig. 2
Giemsa-stained smear of ascitic fluid: Individual lymphocyte shows eccentric cytoplasmic protrusion or blebs giving the appearance of so called hand-mirror morphology (Giemsa).
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Fig. 3
Bone marrow and inguinal lymph node biopsy: (A) The bone marrow biopsy demonstrates lymphoid cells showing nuclear atypical and irregular nuclear contour with occasional convolution and small nucleolus. They are positive for CD3 and negative for CD20 (upper inset, CD3; lower inset, CD20). (B) The inguinal lymph node is diffusely infiltrated by small-sized monomorphic lymphocytes with small amount of pale cytoplasm with 30~40% of Ki-67 labeling index (right lower inset, Ki67). (H&E, inset; immunohistochemical stain).
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Acknowledgments

This work was supported by Inha University Research Grant.

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