Case Series: Malignant Flower Cells in Peripheral Blood

The presence of lymphoid cells with flower-like nuclei in peripheral blood is an uncommon morphologic finding, classically associated with Human T-lymphotropic virus type 1 (HTLV-1) infection related Adult T-cell Leukemia/Lymphoma (ATLL). However, similar cytologic features may be observed in other hematolymphoid malignancies. To describe cases of hematologic neoplasms presenting with flower cells in the peripheral blood and to highlight their broader diagnostic spectrum. We report a series of patients with distinct hematologic malignancies who demonstrated flower cells on peripheral blood smear, thereby expanding the morphologic differential beyond ATLL. Recognition that flower-like nuclear morphology may occur outside the context of ATLL is important for accurate diagnosis and underscores the need to consider a boarder range of hematolymphoid neoplasms in the differential.