Clinical Question

Maryalice Stetler-Stevenson (stetler@box-s.nih.gov)
Mon, 26 Feb 1996 16:34:24 -0400

Clinical Flow People- Especially those with extensive experience in bizarre
reactive T-cells.
Background:
I have a case of a 24 year old white female referred for possible
myelodysplastic syndrome but didn't fit the picture. Since last May her
white count has increased from 6.4 to 8.8. 75% of the peripheral blood
white cells are lymphocytes and almost all T-cells. Examination of a
peripheral smear reveals "reactive" granular lymphgocytes, neutropenia, and
moderate aniso and poikilocytosis. The bone marrow is hypercellular with
M:E of 3-5:1. Megas are normal. There is a left shift in granulocytic and
erythroid maturation. The biopsy shows a moderate sized lymphoid
collection.

Flow: 75% lymphocytes with 97% T-cells. Approximately 70% of the
lymphocytes are CD3+ T-cells with abnormally dim CD2, CD5 and CD7
expression; bright CD8; negative for CD56 and CD16 as well as + for CD38
and HLADR. They are alpha beta T-cells.
I think this is highly abnormal and I bet malignant. Any comments?

Maryalice Stetler-Stevenson
Lab of Path, NCI, NIH