LQCL2209 - CMLE - ATYPICAL LYMPHOCYTOSIS WITH “FLOWER” CELLS IN A PATIENT WITH ADULT T-CELL LEUKEMIA/LYMPHOMA-ATYPICAL LYMPHOCYTOSIS WITH “FLOWER” CELLS IN A PATIENT WITH ADULT T-CELL LEUKEMIA/LYMPHOMA

ATYPICAL LYMPHOCYTOSIS WITH “FLOWER” CELLS IN A PATIENT WITH ADULT T-CELL LEUKEMIA/LYMPHOMA

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The document discusses a case of Adult T-cell Leukemia/Lymphoma (ATLL) in a 55-year-old woman with symptoms like enlarged lymph nodes, fatigue, and night sweats. Lab results showed abnormal white blood cell count, anemia, thrombocytopenia, hypercalcemia, and elevated lactate dehydrogenase. The presence of flower cells in peripheral blood smears indicated ATLL, confirmed by immunophenotypic analysis and positive HTLV-1 test. The disease's clinical subtypes, diagnosis process, and treatment options were described. ATLL is caused by HTLV-1, is prevalent in certain regions like the Caribbean, and has a poor prognosis, often chemoresistant with a median survival of 6 months in the acute subtype. Timely recognition of flower cells on blood smears is crucial for diagnosis. The diagnosis involves a comprehensive evaluation including viral testing for HTLV-1. Treatment includes antiviral therapy, chemotherapy, stem cell transplant, and monoclonal antibody therapies. Hypercalcemia and elevated LDH are significant laboratory findings in ATLL cases. Differential diagnosis includes other T-cell lymphomas. Unfortunately, the patient in the case study did not respond to treatment and was discharged to hospice care. The document also highlights facts about HTLV-1 transmission and screening. In summary, ATLL is a rare but aggressive disease associated with HTLV-1, mainly seen in specific regions, with distinct morphologic and laboratory characteristics aiding in diagnosis and management.

Keywords

Adult T-cell Leukemia/Lymphoma

ATLL

flower cells

HTLV-1

enlarged lymph nodes

chemotherapy

hypercalcemia

lactate dehydrogenase

viral testing

hospice care