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You wrote about a 77 year old male.
PB showed CD4, CD3(cytoplasmic), CD38, CD8 bright positive cells.
CD8 is dim positive. CD45 is dim also.
1. Discordant expression of pan-T markers (cCD3+ and CD3,5,7 -ve) suggests
clonality.
2. Double peaks in T-cell markers (except with CD2), if positive, would also
suggest clonal nature.
3. Coexpression of CD4 & 8, if present, would suggest clonal nature.
4. Morphology (clover leaf nuclei) would also favor a clonal nature.
5. T-cell gene rearrangement would confirm it.
6. Consider HTLV1 serology if morphology/history warrants.
Bakul I. Dalal MD FRCPC FCAP
Division of Hematopathology, LSP1
Vancouver Hospital and Health Sciences Center,
910 West 10th Avenue,
Vancouver, BC, CANADA
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