T-cell lymphoma mimicking granulocytic sarcoma.

Area of Science:

• Hematology
• Oncology
• Immunohistochemistry

Background:

• Diffuse large cell lymphoma (DLCL) is an aggressive non-Hodgkin lymphoma.
• Differential diagnosis of DLCL can be challenging, especially with unusual cellular admixtures.
• Granulocytic sarcoma, a myeloid tumor, can mimic lymphoid malignancies.

Observation:

• A case of DLCL presented with eosinophils and eosinophilic myelocytes alongside neoplastic lymphoid cells.
• Initial diagnostic considerations included granulocytic sarcoma due to the presence of eosinophilic myelocytes.
• Peripheral blood and bone marrow showed no significant abnormalities.

Findings:

• Immunohistochemical analysis of lymph node tissue revealed membrane antigens consistent with helper T-cell lymphoma.
• The neoplastic lymphoid population comprised larger cells, with smaller, irregular lymphoid cells being inconspicuous.
• Despite initial clinical remission, the patient experienced a relapse involving the central nervous system.

Implications:

• This case highlights the importance of comprehensive diagnostic evaluation in complex lymphoma presentations.
• Immunohistochemistry is crucial for accurate subtyping of lymphomas, especially when morphology is atypical.
• Understanding unusual presentations of DLCL can improve diagnostic accuracy and patient management strategies.