case_images: PMC6402200_01
case_images: (a) Positive CD3 immunostaining. (b) Positive CD4 immunostaining. (c) H&E stain with blastic appearing lymphocytes. (d) Positive immunostaining with terminal deoxynucleotidyl transferase (TdT) of the lymphocytes.
case_images: CRIHEM2019-3540487.001.jpg
case_images: PMC6402200_01_CRIHEM2019-3540487.001.jpg
case_images: fig1
case_images: T cells that expressed CD2, CD3, CD5, partial CD57, partial CD52, partial CD26, and alpha/beta receptors (Figure 1). CD7, CD8, and CD30 were not expressed. These atypical lymphocytes had weak and focal expression for BCL2 but negative CD20 and BCL-6 expression. However, both the dermatopathologist and hematopathologist noticed that the morphology of the lymphocytes appear to be blastic in appearance; therefore, immunostain for terminal deoxynucleotidyl transferase (TdT) was performed, which showed diffuse nuclear positivity in the lymphocytes, confirming lymphoblastic nature of these cells (Figure 1).
case_images: (a) 2 x 1 cm lesion on the right lower quadrant of the abdominal wall at first relapse. (b) Enlarging right lower abdominal wall lesion now almost 15 cm x 11.5 cm with ulceration. (c) Break-apart ABL1 fluorescence in situ hybridization (FISH) circles indicate 3 intact ABL1 signals (5'ABL1 (green)/3'ABL1 (red) {9q34}). (d) Enumeration for 9p-circles indicates homozygous loss of CDKN2A (CDKN2A(9p16) red/D9Z19(CEN) green).
case_images: CRIHEM2019-3540487.002.jpg
case_images: PMC6402200_01_CRIHEM2019-3540487.002.jpg
case_images: fig2
case_images: Three months after completion of chemotherapy while undergoing pretransplant evaluation, the patient noticed a slightly raised, erythematous 2 x 1 cm lesion on the right lower quadrant of her abdominal wall (Figure 2). Fluorescence in situ hybridization (FISH) study revealed homozygous CDKN2A deletion (-9p21 x 2) and three intact copies of ABL1 (+9q34) (Figure 2), which aided in confirming the final diagnosis. Unfortunately, her disease progressed after 2 cycles of chemotherapy as evidenced by enlarging right lower abdominal wall lesion, now almost 15 cm wide and 11.5 cm in length with ulceration (Figure 2).