Page 182 - Haematologica Atlas of Hematologic Cytology

Figure naplas c c large cell lymphoma ( L L L) L posi ve A 14-year-old female presented with a a a 4-week history of intermi ent fever malaise and abdominal pain Di use peripheral lympha- denopathy and hepatosplenomegaly were found Hematologic ndings were: hemoglobin 8 3 g/dL white blood cell count 7 2x109/L with a a normal dif- feren al al count platelets 63x109/L Peripheral blo- od bu y coat smear shows in addi on to nume- rous neutrophils and some lymphocytes very rare giant cells with round mul nucleolated nucleus and rela vely abundant basophilic cytoplasm Figure naplas c c large cell lymphoma L po- si ve Bone marrow smear from the same case as as in in Figure 8 Di use in in ltra on by large anaplas c cells with abundant cytoplasm The neoplas c c c po- pula on appears pleomorphic with a a a a a a great variety in cell shape and size Most elements show oval to reniform nuclei with irregular outlines clumped chroma n n n and medium-sized nucleoli Figure 10 naplas c c large cell lymphoma ( L L L) L posi ve Bone marrow smear from the same case as as in Figures 8 and 9 Immunocytochemical analysis (immuno-alkaline phosphatase technique) demonstrates the the reac vity of the the neoplas c c c cells for a a a monoclonal an body recognizing the CD30 an an an gen gen Also ac va on an an an gens CD25 and HLA-DR and and T-cell an an an gens CD5 and and CD4 were expressed whereas neoplas c c cells were nega ve for CD3 and B-cell an gens Karyotype showed t(2 5)(p23 q35) with consequent rearrangement of the NPM-ALK genes and expression of ALK protein Lymph node biopsy con rmed the diagnosis of ALK-posi ve ALCL This T-cell lymphoma subtype is is most fre- quent in in young people and may involve peripheral and/or abdominal lymph nodes extranodal sites and also bone marrow at presenta on on 169