case_images: PMC7443251_01
case_images: Peripheral blood smear (Wright's stain, 100x) shows increased large granular lymphocytes, some of which showed irregular nuclear contours (a). Lymphocytosis is persistent and slowly progressive for more than 11 months of duration (b). Flow cytometry done on the PB (c) showing 37% T cells, including a subpopulation of CD4/CD8 double-positive T cells (10%) expressing TCR alpha/beta, CD57, and cTIA, and a showing dim expression of CD4 and CD7. FCM on PB for T-cell receptor V(beta) region repertoire on CD4/CD8 double-positive population shows more than 70% of the cells fails to express any of the tested V(beta) regions, suggestive of clonal population of T-LGLL (CD3+/CD4+/CD8+/CD57+) (d).
case_images: CRIHEM2020-8839144.001.jpg
case_images: PMC7443251_01_CRIHEM2020-8839144.001.jpg
case_images: fig1
case_images: There was lymphocytosis composed of small mature-looking lymphocytes mixed with some large granular forms, some of which showed irregular nuclear contours (Figure 1(a)). Lymphocytosis is persistent and slowly progressive for more than 11 months of duration (Figure 1(b)). Flow cytometric analysis of T-cell receptor V(a) region repertoire performed on CD4/CD8 double-positive population (on PB) (Figure 1(d)) showed that more than 70% of the cells failed to express any of the tested V(a) regions, a finding that is suggestive of T-cell clonality.
case_images: BM aspirate smear (Wright's stain, 100x) revealing ~18% myeloma plasma cells with a few atypical binucleated forms (a). FCM analysis on BM aspirate (b) showing a population of monotypic plasma cells ~5% expressing CD45, CD38, and CD138 with cytoplasmic kappa light chain restriction and aberrant expression of CD56 and CD117. The plasma cells show no significant expression of CD20. LGLs included the same population of CD4/CD8 double-positive cells (~2%) (red arrow) showing a dimmer expression of CD4 and CD7.
case_images: CRIHEM2020-8839144.002.jpg
case_images: PMC7443251_01_CRIHEM2020-8839144.002.jpg
case_images: fig2
case_images: BM aspirate smear (Figure 2(a)) revealed ~18% myeloma plasma cells with a few atypical binucleate forms and rare immature forms with plasmablastic morphology. Flow cytometry on BM aspirate (Figure 2(b)) showed a population of monotypic plasma cells ~5% expressing CD45, CD38, and CD138 with cytoplasmic kappa light chain restriction and aberrant expression of CD56 and CD117. LGL included a population of CD4/CD8 double-positive cells (~2% of total cells) showing a dimmer expression of CD4 and CD7 (similar to the population detected earlier on peripheral blood) (Figure 2(b), red arrow).