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Leukaemic presentation of angioimmunoblastic T-cell lymphoma

A 62-year-old female presented with a 3-month history of poor appetite, cervical lymphadenopathy and an erythematous macular rash over her face, trunk and limbs. A full blood count showed: haemoglobin concentration 118 g/l, white cell count 1385 9 109/l, lymphocyte count 101 9 109/l and platelet count 146 9 109/l. The lymphocytes were small to medium-sized with scanty, faintly basophilic cytoplasm (image). Peripheral blood flow cytometric immunophenotyping showed an expanded population (82%) of T lymphocytes that were positive for CD3, CD2, CD5 and TCR-ab with aberrant loss of CD7. These cells were negative for CD4/CD8, CD34, CD10 and terminal deoxynucleotidyl transferase. Cervical lymph node biopsy showed extensive effacement by angioimmunoblastic T-cell lymphoma (AITL). Skin and

First published online 27 June 2014 doi: 10.1111/bjh.12998

bone marrow biopsies confirmed involvement by T-cell lymphoma. The patient received six cycles of etoposide, doxorubicin, cyclophosphamide, vincristine and prednisone (EPOCH) but had progressive disease 2 months after completing therapy. A leukaemic phase of lymphoma is usually seen in the context of indolent B-cell lymphomas, B and T prolymphocytic leukaemias and, less commonly, aggressive lymphomas such as diffuse large B-cell lymphoma and blastoid mantle cell lymphoma. It is rare in AITL. Kenneth Weicong Lin1,2, Yuh Shan Lee2 and Colin Phipps2 1

Monash University, Melbourne, Vic., Australia and 2Department

of Haematology, Singapore General Hospital, Singapore, Singapore. E-mail: [email protected]

ª 2014 John Wiley & Sons Ltd British Journal of Haematology, 2014, 166, 808

Leukaemic presentation of angioimmunoblastic T-cell lymphoma.

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