Uncommon Variant of CD4+ T-cell Large Granular Lymphocytic Leukemia

Abstract Introduction/Objective T-cell large granular lymphocytic leukemia (T-LGL) is a lymphoma with persistently increased lymphocytes in peripheral blood. The majority of T-LGL associated CD8+ T-cells. However, the CD4+ variant uncommonly seen. Methods/Case Report patient 49-year-old female history diabetes mellites and anemia who presented shortness breath, lower extremities edema, fatigue. Physical examination showed significantly distended abdomen. CBC results hemoglobin 6.9 g/dL, WBC 18.2 × 109/L 88% lymphocytes, PLT 190,000. blood smear lymphocytosis LGL cells, microcytic anemia, target cells. Bone marrow biopsy lymphoid infiltrate as an intravascular pattern confirmed by immunochemical stains. A complete workup including flow cytometric, cytogenetics, molecular studies was performed on bone marrow. phenotype shows positivity for CD2, CD3, CD4, CD5 (bright), CD7 (partial/dim), CD56, CD57 (majority), TCRαβ. gene rearrangement detected further PCR detection clonal TCR beta rearrangements genetics analysis. STAT3 not detected. diagnosed leukemia. Results (if Case Study enter NA) NA. Conclusion CD4+CD8- immunophenotype uncommon T-LGL, which has high incidence activating STAT5B mutation, while CD8+CD4- T-LGLL tends to have mutation. Clinically, those two subtypes behave similarly. Flow cytometry golden method confirm diagnosis. More research needed clarify essence T-LGLL.