How I diagnose large granular lymphocytic leukemia
Min Shi1, William George Morice1
1Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US.
Insights
Diagnosing large granular lymphocytic leukemia (LGLL) is complex due to overlapping features. Accurate diagnosis requires integrating clinical, morphologic, immunophenotypic, clonal, and molecular findings to meet established criteria.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Large granular lymphocytic leukemia (LGLL) is a rare, indolent neoplasm of mature T or NK cells.
- Diagnosis can be challenging due to overlapping features with reactive conditions and other mimickers.
Purpose of the Study:
- To elucidate the differentiation of LGLL from its mimics.
- To highlight potential diagnostic pitfalls in LGLL diagnosis.
Main Methods:
- Presentation of two challenging LGLL cases.
- Comprehensive review of clinicopathologic features of LGLL.
Main Results:
- LGLL exhibits diverse clinical, morphological, immunophenotypic, and molecular profiles.
- These features overlap with reactive conditions and clonal disorders of uncertain significance.
Conclusions:
- Accurate LGLL diagnosis necessitates a multifaceted approach.
- Integration of clinical, morphologic, immunophenotypic, clonal, and molecular data is crucial.
- Adherence to major and minor diagnostic criteria ensures accurate LGLL identification.
Objectives:
Large granular lymphocytic leukemia (LGLL) represents a rare neoplasm of mature T cells or natural killer (NK) cells, with an indolent clinical course. Diagnosing LGLL can be challenging because of overlapping features with reactive processes and other mimickers.
Methods:
By presenting 2 challenging cases, we elucidate the differentiation of LGLL from its mimics and highlight potential diagnostic pitfalls. A comprehensive review of the clinicopathologic features of LGLL was conducted.
Results:
Large granular lymphocytic leukemia displays a diverse spectrum of clinical presentations, morphologies, flow cytometric immunophenotypes, and molecular profiles. These features are also encountered in reactive conditions, T-cell clones of uncertain significance, and NK cell clones of uncertain significance.
Conclusions:
In light of the intricate diagnostic landscape, LGLL workup must encompass clinical, morphologic, immunophenotypic, clonal, and molecular findings. Meeting major and minor diagnostic criteria is imperative for the accurate diagnosis of LGLL.
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