Leukaemia as a manifestation of large cell lymphoma

A leukaemic phase is uncommon in large cell lymphoma, particularly at presentation of the disease, and very few cases have been reported since immunological markers became available. We have studied 24 cases presenting over a period of 15 years. 16 were B-lineage and eight T-lineage. In five patients the large cell lymphoma represented a transformation of a preceding low grade, small cell lymphoproliferative disease. Three other patients with T-lineage large cell lymphoma presented with skin infiltration (two cases) or lymphoma-associated nephrotic syndrome (one case) 3-9 months before leukaemia occurred. The other 16 patients (12 B-lineage and four T-lineage) presented with de novo large cell leukaemia/lymphoma. With the exception of skin infiltration, clinical features did not differ between T and B-lineage cases. Prognosis was generally poor although a minority of patients lived 1-2 years. Median survival was 7 months. In the B-cell lymphomas immunological markers were those expected but among the T-cell cases there were many unusual immunophenotypes with frequent failure to express markers which are usually positive in peripheral T cells. Without the availability of immunological markers diagnosis would have been difficult, with acute myeloid leukaemia being the most important differential diagnosis. T-lineage and B-lineage cases could not be distinguished on cytological features. In the majority of cases the cells were very pleomorphic with nuclear lobulation, prominent nucleoli and marked cytoplasmic basophilia being commonly observed. Marked nuclear lobulation was not confined to T-lineage cases but was seen also in seven of 12 cases of de novo B-lineage leukaemia/lymphoma; it was readily apparent in histological sections and on ultrastructural examination.