A T-cell prolymphocytic leukemia case with central nervous system involvement

Area of Science:

• Hematology
• Oncology
• Neurology

Background:

• T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive mature T cell neoplasm.
• It typically affects the peripheral blood, bone marrow, lymph nodes, and spleen.
• T-PLL accounts for 2-5% of mature lymphocytic leukemias in adults.

Observation:

• A 74-year-old male initially diagnosed with chronic lymphocytic leukemia (CLL) presented with neurological symptoms after chemotherapy.
• Brain MRI revealed contrast enhancement around cranial nerves, indicating lymphoproliferative involvement.
• Cerebrospinal fluid cytology and bone marrow biopsy confirmed T-cell prolymphocytic leukemia (T-PLL).

Findings:

• Central nervous system (CNS) involvement is a rare manifestation of T-PLL.
• Distinguishing T-PLL from CLL is crucial due to overlapping clinical presentations like splenomegaly and lymphocytosis.
• Accurate diagnosis requires careful consideration of clinical, cytological, and histopathological findings.

Implications:

• This case underscores the importance of considering T-PLL in the differential diagnosis of neurological symptoms, especially in patients with suspected or diagnosed lymphoid leukemia.
• Early and accurate diagnosis of T-PLL with CNS involvement is critical for appropriate management and potentially improving patient outcomes.
• Further research into the specific mechanisms and clinical characteristics of T-PLL CNS involvement may be warranted.