case_images: PMC11371457_01
case_images: Exemplary transverse section of the staging CT image at initial diagnosis: the number of thoracic lymph nodes is clearly increased.
case_images: CRIHEM2024-4303614.001.jpg
case_images: PMC11371457_01_CRIHEM2024-4303614.001.jpg
case_images: fig1
case_images: Contrast-enhanced computed tomography (CT, neck/thorax/abdomen, Figure 1) showed increased, partially enlarged lymph nodes, bilaterally cervical, axillary, retroperitoneal/paraaortic, and inguinal, as well as a slightly plump, discretely enlarged spleen (pole-to-pole 11.5 cm) with homogeneous parenchyma.
case_images: Cardiac MRI imaging at initial diagnosis after cardiovascular bypass surgery: infarct scar (over 75% transmural) on the left ventricular posterior wall and a normally dimensioned left ventricle with significantly reduced left ventricular function.
case_images: CRIHEM2024-4303614.002.jpg
case_images: PMC11371457_01_CRIHEM2024-4303614.002.jpg
case_images: fig2
case_images: Cytomorphological findings in peripheral blood at initial diagnosis (magnification 100x): blood smear showing aberrant lymphoid cells with partially scored nuclei, including prominent nucleoli, and deep basophilic cytoplasm with multiple small protrusions (blebs) consistent with T-PLL.
case_images: CRIHEM2024-4303614.003.jpg
case_images: PMC11371457_01_CRIHEM2024-4303614.003.jpg
case_images: fig3
case_images: T-PLL could be established with a main criterion of mature T-cell immunophenotype and a secondary criterion of chromosomal aberration with an increase to 8q in 03/21. The cytomorphology characteristic of T-PLL is shown as an example in Figures 3 and 4.
case_images: Findings in bone marrow at initial diagnosis (magnification 100x): prominent infiltration (approx. 70% of nucleated cells) by atypical small T-cells with prolymphocytic morphology. Lymphoid-appearing cells with mostly mature nuclear chromatin and slightly enlarged and shape-variable nuclei. In addition, repressed myelopoiesis with slightly increased eosinophilic granulocytes.
case_images: CRIHEM2024-4303614.004.jpg
case_images: PMC11371457_01_CRIHEM2024-4303614.004.jpg
case_images: fig4
case_images: T-PLL could be established with a main criterion of mature T-cell immunophenotype and a secondary criterion of chromosomal aberration with an increase to 8q in 03/21. The cytomorphology characteristic of T-PLL is shown as an example in Figures 3 and 4.
case_images: Kinetics of leukocytes in peripheral blood (G/l, measured by flow cytometry, reference range 3.6-10.5 G/l) over time (days) since emergency presentation with ACS.
case_images: CRIHEM2024-4303614.005.jpg
case_images: PMC11371457_01_CRIHEM2024-4303614.005.jpg
case_images: fig5
case_images: After a continuous increase in the leucocyte count to 90 G/l at the end of 06/21 (Figure 5), the patient received cytoreductive therapy with cyclophosphamide/dexamethasone (200 mg/12 mg absolute/day) for five days.