Page 356 - Concise Pathology for Exam Preparation ( PDFDrive )

12 Haematology 341

3. Peripheral T-cell lymphoma (not otherwise specified or NOS)
(a) Refers to a group of diseases that do not fit into any of the other subtypes of PTCL
(CD4 and CD81, CD4.CD8; antigen loss frequent 2 CD7, CD5, CD4/CD8,
CD52; CD302/1, CD562/1, CD102, BCL62, CLCX132, PD12).
(b) It constitutes 25% of all PTCLs.
(c) Its differential diagnosis includes:
(i) Angioimmunoblastic lymphoma: CD41 or mixed CD4/8, CD101/2, BCL61/2,
CXCL131, PD11, hyperplasia of FDC, EBV1CD201 B blasts
(ii) Adult T cell leukaemia/lymphoma: CD41, CD251, CD72, CD302/1,
CD152/1, FoxP31/2
(iii) Anaplastic large cell lymphoma: CD301, ALK1/2, EMA1, CD251, cytotoxic
granules1, CD41/2, CD32/1, CD431
(iv) T cell rich large B cell lymphoma: Large CD201 blasts in background of
reactive CD31 T cells
(v) T-zone hyperplasia: Mixed CD4/CD8, intact architecture, variable CD25 and
CD30; scattered CD201 B cells

Laboratory Findings in NHL

Haematological abnormalities:
1. Anaemia of normocytic normochromic type
2. Advanced disease with marrow infiltration nneutropenia, thrombocytopenia and
leucoerythroblastic picture
3. Leukaemic conversion of NHL
4. Hyperuricaemia and hypercalcaemia late in the disease

Q. Outline the types, clinical features and laboratory diagnosis of
chronic lymphocytic leukaemia (CLL).
9
Ans. CLL is characterized by a persistent lymphocytosis of at least 10 3 10 with infiltration
of the bone marrow, spleen and lymph nodes.
Types

More than 95% of the cases are B-CLL; 5% are T-CLL

Clinical Features
• Most common form of chronic leukaemia in the Western world, usually seen in patients
over 50 years; M . F.
• Patients may be asymptomatic or present with generalized lymphadenopathy and hepa-
tosplenomegaly.
• Recurrent infections due to hypogammaglobulinaemia/synthesis of abnormal immuno-
globulins and neutropenia.
• Haemorrhagic manifestations, eg, purpura, due to thrombocytopenia (impaired platelet
production as normal marrow replaced by leukaemic cells, as well as immune destruction
of platelets and hypersplenism).
• Constitutional symptoms due to raised metabolic rate (malaise, anorexia, weight loss,
fever and night sweats)

Investigations
• Mild to moderate anaemia due to:
(a) Marrow replacement by leukaemic cells
(b) Autoimmune haemolysis
(c) Folate deficiency
(d) Hypersplenism
• Total leukocyte count is raised.

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