T-幼淋巴细胞白血病在淋巴结穿刺活检中的诊断特征OA

Objective To investigate the diagnostic features of T-prolymphocytic leukemia(T-PLL)in lymph node core needle biopsy specimens and its differential diagnosis from other mature T/NK-cell leukemias/lymphomas.Methods Clinical data and pathological specimens from five patients with T-PLL were collected.Immunohistochem-istry was performed using the EnVision two-step method.Epstein-Barr virus infection status was assessed by EBER in situ hybridization.T-cell receptor(TCR)gene rearrangements were analyzed by polymerase chain reaction followed by capillary electrophoresis.Immunophenotyping was performed by flow cytometry,and conventional cytogenetic analysis was performed using RHG banding.Targeted next-generation sequencing(NGS)of 84 T-cell lymphoma-related genes was also performed.Results Three reproducible morphologic features were identified in lymph node core needle bi-opsy specimens of T-PLL:tumor cells had moderately condensed,finely textured chromatin;tumor cells formed con-centric perivascular layers with an onion-skin appearance;and residual B cells showed an island-like distribution.The tumor cells expressed CD2,CD3,CD5,CD7,TCL1A,and CD52 and showed two CD4/CD8 expression patterns.EBER in situ hybridization was negative in four cases,whereas only scattered cells were positive in one case.Flow cy-tometry detected an abnormal mature T-cell clone in the bone marrow of all five patients,and the immunophenotypic findings were consistent with the histologic findings.Clonal TCR gene rearrangements were detected in all five cases.Cytogenetic analysis was completed in four cases,two of which showed complex karyotypic abnormalities.Targeted NGS was performed in four cases and identified somatic mutations in genes including ATM,JAK3,STAT5B,and NOTCH1.Conclusion The three characteristic morphologic features of T-PLL in lymph node core needle biopsy specimens may help pathologists recognize this entity in challenging lymph node biopsy cases and reduce misdiagnosis.