Agranular CD4+ NK cell lymphoma/leukemia

From: kcdol@samsung.co.kr
Date: Wed Dec 17 1997 - 11:55:01 EST


Dear flowers

I posted a case of CD4+CD16/56+ NK cell lymphoma and want
to add a little more information about it.

The male patient was born in 1977 (20 years old) and
visited our hospital in 1995 because of lymphadenopathy.
His inguinal lymph node demonstrated infiltration of
medium to large sized agranular lymphoid cells which had
high N/C ratio, no vacuoles, some cytoplasmic projections,
and nuclear irregularities.

At that time, immunohistochemical stain showed CD43+, CD56+, CD45RO-,
CD3-, and CD20-. TCR beta gene rearranement was absent and
EBV in-situ hybridization negative. TCR gamma gene Southern
hybridization study on frozen tissue was negative, either.

Three months later, skin involvement of the same abnormal lymphoid
cells was noticed on right leg.

This month, we found the same cells in peripheral blood and bone
marrow which showed positivity with CD4, CD16/56 mixture, and CD45
but negativity with CD2, CD5, CD7, CD3, CD10, CD19, CD20, CD23, CD25,
FMC7, kappa, lambda, CD1
4, and nuclear TdT.

I tried to find reported cases and made some success.
Reference.
  Acute agranular CD4-positive natural killer cell leukemia.
  Brody JP, et al. Cancer 1995;75:2474-83

  High expression of CD56 (N-CAM) in a patient with cutaneous
  CD4-positive lymphoma.
  Adachi M, et al. Am J Hematol 1994;47:278-82

  A primary cutaneous non-T, non-B CD4+, CD56+ lymphoma.
  Dummer R, et al. Arch Dermatol 1996;132:550-3

I welcome any input from anyone who is intested in this case
and thanks for your time.

Chang-Seok Ki, MD
3rd-year resident
Dept. of Clin Path
Samsung Medical Center
Seoul, Korea



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