Aug 3, 2017 - lymphocytosis (panel A [original magnification 31000, May-Grünwald–Giemsa stain]) and thrombopenia, and demonstrated a CD4. 1. /CD8. 1.
From www.bloodjournal.org by guest on August 27, 2017. For personal use only.
bloodwork ®
IMAGES
IN HEMATOLOGY
Broken heart by T-prolymphocytic leukemia A
B
C
D
E
c Christian Arranto and Alexandar Tzankov, University Hospital Basel
A
68-year-old man presented with rapidly progressive dyspnea due to newly diagnosed heart failure. Cardiac magnetic resonance imaging was compatible with myocarditis. Coronary angiography showed no relevant stenosis. The endomyocardial biopsy showed a multifocal, partially active lymphocytic myocarditis. Four years later, a bone marrow biopsy was performed due to lymphocytosis (panel A [original magnification 31000, May-Gr¨unwald–Giemsa stain]) and thrombopenia, and demonstrated a CD41/CD81 double-positive T lymphocytosis with a biclonal T-cell receptor rearrangement. Cytogenetics revealed a complex karyotype including an inversion of chromosome 14 and isodicentric chromosome 8. The diagnosis of T-prolymphocytic leukemia (T-PLL) was established. The patient received a left ventricular assist device due to progressive heart failure. The apical myocardial biopsy showed destructive lymphocytic infiltration by the T-PLL (panels B [original magnification 3400, hematoxylin and eosin stain], C [CD3], D [CD4], and E [CD8] [C-E; original magnification 3200, immunohistochemistry]), which was proven to be of the same clonal T-cell origin as in the bone marrow. Reanalysis of the myocardial biopsy taken 4 years earlier revealed a clonal T-cell population matching with 1 of the current T-cell gene rearrangement products. The patient was treated with alemtuzumab, followed by a cytokine storm. He refused further treatment and died soon after. This case illustrates a destructive cardiac infiltration by T-PLL causing severe heart failure.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org. DOI 10.1182/blood-2017-05-784363 BLOOD, 3 AUGUST 2017 x VOLUME 130, NUMBER 5
© 2017 by The American Society of Hematology 691
From www.bloodjournal.org by guest on August 27, 2017. For personal use only.
2017 130: 691 doi:10.1182/blood-2017-05-784363
Broken heart by T-prolymphocytic leukemia Christian Arranto and Alexandar Tzankov
Updated information and services can be found at: http://www.bloodjournal.org/content/130/5/691.full.html Articles on similar topics can be found in the following Blood collections BloodWork (557 articles) Free Research Articles (4666 articles) Lymphoid Neoplasia (2612 articles) Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml
Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved.
