case_images: PMC9985503_01
case_images: Computed tomography revealed multiple lymph node swellings. Computed tomography scans at the first visit (a, b, and c) and four months later (d, e, f, and g), shows the cervical lymph nodes (a, d), axillary lymph nodes (b, e), mediastinal lymph nodes (c, f), and para-aortic lymph node (g).
case_images: CRIHEM2023-3628712.001.jpg
case_images: PMC9985503_01_CRIHEM2023-3628712.001.jpg
case_images: fig1
case_images: Computed tomography revealed cervical, axillary, and mediastinal lymph node swelling measuring up to 20 mm (Figures 1(a) -1(c)). A computed tomography (CT) scan showed that the lymph nodes had further increased in size since the CT scan was performed four months previously, and para-aortic lymphadenopathy was also noted (Figures 1(d) -1(g)).
case_images: Flow cytometry analysis of bone marrow cells. (a) Flow cytometry showed a small immature cell population coexpressing T cell and myeloid markers. (b) Two populations of leukemic cells were found: one with myeloperoxidase (MPO) strongly positive and cytoplasmic CD3 (cyCD3) weakly positive cells and the other with MPO weakly positive and cyCD3 strongly positive cells. cyCD3, cytoplasmic CD3; MPO, myeloperoxidase; TdT, terminal deoxynucleotidyl transferase.
case_images: CRIHEM2023-3628712.002.jpg
case_images: PMC9985503_01_CRIHEM2023-3628712.002.jpg
case_images: fig2
case_images: The May-Giemsa stain of the bone marrow aspirate did not detect any abnormal cells, but in flow cytometry, the CD45/side scatter (SCC) gating procedure identified a small immature cell population coexpressing T cell and myeloid markers, terminal deoxynucleotidyl transferase (TdT), cytoplasmic CD3, CD34, and myeloperoxidase (MPO) (Figure 2(a)). In flow cytometry analysis, the CD45/side scatter (SCC) gating procedure revealed two blast populations: MPO strongly positive and cytoplasmic CD3 (cyCD3) weakly positive blasts, and MPO weakly positive and cyCD3 strongly positive blasts (Figure 2(b)). CD7, TdT, and CD13 (Figure 2(b)). Chromosomal karyotyping revealed a normal karyotype (46 XY).
case_images: Histopathological examination of a cervical lymph node biopsy showing T/myeloid mixed phenotype acute leukemia cells, indicating extramedullary involvement. Hematoxylin and eosin stain ((a) x40; (b) x400) and immunohistochemical stain for terminal deoxynucleotidyl transferase (c), CD3 (d), CD34 (e), myeloperoxidase (f), and c-kit (g). HE, hematoxylin and eosin; MPO, myeloperoxidase; TdT, terminal deoxynucleotidyl transferase.
case_images: CRIHEM2023-3628712.003.jpg
case_images: PMC9985503_01_CRIHEM2023-3628712.003.jpg
case_images: fig3
case_images: These blastoid cells were positive for TdT, CD34, MPO, CD3, and c-kit (Figures 3(a)-3(f)).