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

Korean J Cytopathol. 2008 Sep;19(2):168-172. English.
Published online September 30, 2008.
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.


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


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).
Click for larger image

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).
Click for larger image

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).
Click for larger image


This work was supported by Inha University Research Grant.

1. Catovsky D, Ralfkiaer E, Muller-Hermelink HK. T-cell prolymphocytic leukemia. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, editors. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001. pp. 195-196.
2. Valbuena JR, Herling M, Admirand JH, et al. T-cell prolymphocytic leukemia involving extramedullary sites. Am J Clin Pathol 2005;123:456–464.
3. Herling M, Khoury JD, Washington LT, Duvic M, Keating MJ, Jones D. A systematic approach to diagnosis of mature T-cell leukemias reveals heterogeneity among WHO categories. Blood 2004;104:328–335.
4. Matutes E, Brito-Babapulle V, Swansbury J. Clinical and laboratory features of 78 cases of T-prolymphocytic leukemia. Blood 1991;78:3269–3274.
5. Hoyer JD, Ross CW, Li CY, et al. True T-cell chronic lymphocytic leukemia: a morphologic and immunophenotypic study of 25 cases. Blood 1995;86:1163–1169.
6. Matutes E, Garcia Talavera J, O'Brien M, Catovsky D. The morphological spectrum of T-prolymphocytic leukaemia. Br J Haematol 1986;64:111–124.
7. Weinstein LJ, Cibas ES. Effusions. In: Atkinson BF, editor. In Atlas of Diagnostic Cytopathology. 2nd den. Philadelphia: Saunders; 2004. pp. 111-113.
8. Shimoni A, Shvidel L, Shtalrid M, Klepfish A, Berrebi A. Prolymphocytic transformation of B-chronic lymphocytic leukemia presenting as malignant ascites and pleural effusion. Am J Hematol 1998;59:316–318.
9. Siderits R, Godyn J, Tufankjian D, Ouattara O. T-cell lymphoproliferative disorder of hand-mirror cell morphology presenting in an eosinophilic loculated peritoneal effusion, with omental "caking". Cytojournal 2006;3:13.
10. Spieler P, Kradolfer D, Schmid V. Immunocytochemical characterization of lymphocytes in benign and maligannt lymphocytes-rich serous effusions. Virchows Arch A Pathol Anat Histopathol 1986;409:211–221.
11. Mihaescu A, Gebhard S, Chaubert P, et al. Application of molecular genetics to the diagnosis of lymphocyte-rich effusions: study of 95 cases with concomitant immunophenotyping. Diagn Cytopathol 2002;27:90–95.
12. Spieler P. The cytologic diagnosis of tuberculosis in pleural effusions. Acta Cytol 1979;23:374–378.
13. Seidel TA, Garbes AD. Cellues grumelees: old terminology revisited: regarding the cytologiv diagnosis of chronic lymphocytic leukaemia and well differentiated lymphocytic lymphoma in pleural effusion. Acta Cytol 1985;29:775–780.