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Case Series: Malignant Flower Cells in Peripheral Blood.

Ursula Matos1, Wan Ying Tan2, Kapil Meleveedu2

  • 1Department of Internal Medicine, University of Connecticut School of Medicine, FARMINGTON, USA.

Turk Patoloji Dergisi
|May 14, 2026
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Flower cells in peripheral blood are typically linked to Adult T-cell Leukemia/Lymphoma (ATLL). This study reveals these unique cells can appear in various hematologic neoplasms, broadening the diagnostic scope beyond ATLL.

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Area of Science:

  • Hematology
  • Cytopathology
  • Oncology

Background:

  • Flower cells, characterized by flower-like nuclei, are an uncommon peripheral blood finding.
  • This morphology is classically associated with Human T-lymphotropic virus type 1 (HTLV-1) infection and Adult T-cell Leukemia/Lymphoma (ATLL).

Purpose of the Study:

  • To document hematologic neoplasms presenting with flower cells in peripheral blood.
  • To expand the diagnostic considerations for this cytologic feature beyond ATLL.

Main Methods:

  • Retrospective review of peripheral blood smear findings.
  • Correlation of cytologic morphology with final hematologic diagnoses.

Main Results:

  • Identified cases of diverse hematologic malignancies exhibiting flower cells.
  • Demonstrated that flower-like nuclear morphology is not exclusive to ATLL.

Conclusions:

  • Flower cells in peripheral blood can be indicative of a broader spectrum of hematologic neoplasms.
  • Recognizing this expanded differential is crucial for accurate diagnosis and patient management.