Pathology Discovery

Pathology Discovery

ISSN 2052-7896
Case report

Development of T-cell large granular lymphocytic leukemia in the course of B-cell chronic lymphocytic leukemia with a causal relationship inferred from a flow cytometric analysis of the bone marrow aspirate

Andrew M. Plata1, James N. Frame2, Jeremy Stuelpnagel3, Tajana Juranovic4, Oscar C. Estalilla5 and Tomislav M. Jelic5*

*Correspondence: Tomislav M. Jelic tjelic@suddenlink.net

5. Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, 3200 MacCorkle Ave, Charleston, WV 25304, USA.

Author Affiliations

1. Autonomous University of Guadalajara, Mexico.

2. David Lee Cancer Center, Charleston WV, 25304, USA.

3. Department of Pathology, West Virginia University, Morgantown, WV 26506, USA.

4. Clinical Hospital Centre Rijeka, University of Rijeka, Rijeka, Croatia.

Abstract

Background: B-cell chronic lymphocytic leukemia is the most frequent leukemia in the western world while T-cell large granular lymphocytic leukemia with cytotoxic (CD8+/CD3+CD4-) immunophenotype is rare. There is much ongoing interest regarding the interaction between T cells and B-cell chronic lymphocytic leukemia cells.

Methods: Peripheral blood and bone marrow samples from a 72 year-old-man with a simultaneous presence of these two types of leukemia were examined and analyzed by conventional morphology, flow cytometry, immunohistochemistry, chromosomal study, and molecular studies.

Results: Flow cytometric analysis of the bone marrow aspirate documented B-cell chronic lymphocytic leukemia, CD3+ CD8+ T-cell large granular lymphocytic leukemia, and demonstrated the presence of three subpopulations of CD8+ T-cells with transitional immunophenotypes between that of benign and malignant CD8+ T-cells.

Conclusions: We report the first case of simultaneous presence of B-cell chronic lymphocytic leukemia and T-cell large granular lymphocytic leukemia with cytotoxic (CD8+/CD3+/CD4-) immunophenotype. The simultaneous presence of malignant CD8+ CD3+ T-cell large granular lymphocytes together with the three immunophenotypically different subpopulations of CD3+ CD8+ T-cells indicated an ongoing stepwise malignant transformation of large granular lymphocytes late in the 9-year-course of B-cell chronic lymphocytic leukemia. We propose that chronic antigenic stimulation by B-cell chronic lymphocytic leukemia cells and immune deficiency inherent to B-cell chronic lymphocytic leukemia additionally augmented by treatment with fludarabine, may cause development of T-cell large granular lymphocytic leukemia.

Keywords: B-cell chronic lymphocytic leukemia, T-cell large granular lymphocytic leukemia, bone marrow, cytotoxic

ISSN 2052-7896
Volume 3
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