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T cell lymphoblastic lymphoma with uncommon CD20 expression.

Ramón Diez-Feijóo1, Juan José Rodríguez-Sevilla1, Marta Salido1

  • 1Department of Hematology, Hospital del Mar, Barcelona, Spain.

International Journal of Laboratory Hematology
|November 25, 2021
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Summary

This case study highlights T lymphoblastic lymphoma (T-LBL) with unusual CD20 expression, which can mimic B-cell lymphoma. Confirming T-cell receptor gene rearrangements is crucial for accurate diagnosis.

Keywords:
CDKN2ANOTCH2CD20T lymphoblastic lymphoma

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Area of Science:

  • Hematology
  • Oncology
  • Immunophenotyping

Background:

  • T lymphoblastic lymphoma (T-LBL) is an aggressive non-Hodgkin lymphoma.
  • Accurate diagnosis relies on characteristic immunophenotypic and molecular markers.
  • CD20 expression is typically associated with B-cell lymphoid neoplasms.

Observation:

  • A case of T-LBL presented with aberrant CD20 expression.
  • Immunophenotyping revealed TdT, CD3, and CD7 positivity, consistent with T-lineage.
  • Non-T lineage markers (CD79a, myeloid antigens) were negative.

Findings:

  • Molecular analysis confirmed clonal T-cell receptor (TCR) gamma and beta chain rearrangements.
  • Cytogenetic analysis identified deletions in CDKN2A and NOTCH2 genes.
  • The presence of CD20 in T-LBL poses a diagnostic challenge, potentially leading to misdiagnosis as B-cell lymphoblastic lymphoma (B-LBL).

Implications:

  • Distinguishing T-LBL from B-LBL is critical for appropriate treatment selection.
  • Combined analysis of immunoglobulin heavy chain (IGH) and TCR gene rearrangements is essential when CD20 is expressed in T-LBL.
  • This case underscores the importance of comprehensive diagnostic workup in lymphoid neoplasms.