1
|
Libonati R, Soda M, Statuto T, Valvano L, D’Auria F, D’Arena G, Pietrantuono G, Villani O, Mansueto GR, D’Agostino S, Di Somma MD, Telesca A, Vilella R. T-Large Granular Lymphocytic Leukemia with Hepatosplenic T-Cell Lymphoma? A Rare Case of Simultaneous Neoplastic T-Cell Clones Highlighted by Flow Cytometry and Review of Literature. Biomedicines 2024; 12:993. [PMID: 38790955 PMCID: PMC11117647 DOI: 10.3390/biomedicines12050993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Lymphoproliferative diseases are a heterogeneous set of malignant clonal proliferations of lymphocytes. Despite well-established diagnostic criteria, the diagnosis remains difficult due to their variety in clinical presentation and immunophenotypic profile. Lymphoid T-cell disorders are less common than B-cell entities, and the lack of a clear immunophenotypic characteristic makes their identification hard. Flow cytometry turned out to be a useful tool in diagnosing T-cell disorders and to resolve complicated cases, especially if the number of analyzable neoplastic cells is small. We present a case of a 55-year-old man with simultaneous lymphoproliferative neoplastic T-cell clones, one αβ and the other γδ, identified and characterized by flow cytometry (FC), exploiting the variable expression intensity of specific markers. However, the patient's rapid decline made it impossible to define a differential diagnosis in order to confirm the identity of the γδ clone, which remains uncertain. This case is added to the few other cases already documented in the literature, characterized by the co-existence of T-large granular lymphocytic leukemia (T-LGLL)-αβ and T-LGLL-γδ/Hepatosplenic T-cell lymphoma (HSTCL). Our case underlines the key role of sensitive diagnostic tools in the assessment of potential relationship between the diagnosis, prognosis, and treatment in the two pathologies.
Collapse
Affiliation(s)
- Rossana Libonati
- Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero In Vulture, Italy; (R.L.); (M.S.); (A.T.); (R.V.)
| | - Michela Soda
- Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero In Vulture, Italy; (R.L.); (M.S.); (A.T.); (R.V.)
| | - Teodora Statuto
- Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero In Vulture, Italy; (R.L.); (M.S.); (A.T.); (R.V.)
| | - Luciana Valvano
- Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero In Vulture, Italy; (R.L.); (M.S.); (A.T.); (R.V.)
| | - Fiorella D’Auria
- Laboratory of Clinical Pathology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero In Vulture, Italy;
| | - Giovanni D’Arena
- Immunohematology and Transfusional Medicine, “S. Luca” Hospital, ASL Salerno, 84078 Vallo della Lucania, Italy;
| | - Giuseppe Pietrantuono
- Hematology and Stem Cell Transplantation Unit, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy; (G.P.); (O.V.); (G.R.M.); (S.D.)
| | - Oreste Villani
- Hematology and Stem Cell Transplantation Unit, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy; (G.P.); (O.V.); (G.R.M.); (S.D.)
| | - Giovanna Rosaria Mansueto
- Hematology and Stem Cell Transplantation Unit, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy; (G.P.); (O.V.); (G.R.M.); (S.D.)
| | - Simona D’Agostino
- Hematology and Stem Cell Transplantation Unit, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy; (G.P.); (O.V.); (G.R.M.); (S.D.)
| | - Massimo Dante Di Somma
- Anatomical Pathology Department, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy;
| | - Alessia Telesca
- Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero In Vulture, Italy; (R.L.); (M.S.); (A.T.); (R.V.)
| | - Rocchina Vilella
- Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero In Vulture, Italy; (R.L.); (M.S.); (A.T.); (R.V.)
| |
Collapse
|
2
|
Muacevic A, Adler JR, Gomes V, Castro Gomes G. Febrile Neutropenia as the First Manifestation of T-Cell Large Granular Lymphocytic Leukemia. Cureus 2022; 14:e31274. [PMID: 36505171 PMCID: PMC9732502 DOI: 10.7759/cureus.31274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
T-cell large granular lymphocytic (T-LGL) leukemia is a rare lymphoproliferative disorder, characterized by peripheral blood and bone marrow infiltration with large granular lymphocytes (LGL), splenomegaly, cytopenias, and a frequent association with autoimmune diseases. Recurrent bacterial infections due to neutropenia are the main reason why patients come to medical attention. Despite not being a curable disease, T-LGL leukemia usually has an indolent course, with deaths mainly resulting from severe infections. Treatment is often not required, however, when needed, aims to relieve symptoms, and reduce infections and transfusion needs. We describe a case of an 86-year-old female patient with febrile neutropenia, diagnosed with T-LGL leukemia after the resolution of infection and exclusion of other causes of neutropenia. A "watch and wait" approach was established after a multidisciplinary discussion. This case shows a frequent presentation of a rare disease, as well as the approach from diagnosis to treatment, reminding clinicians that T-LGL leukemia should be considered in the differential diagnosis of adults with febrile neutropenia.
Collapse
|