Unusual Case

From: Lucille H Kimura (lucille_h.kimura@TAMC.CHCS.AMEDD.ARMY.MIL)
Date: Wed Sep 20 2000 - 18:03:57 EST


Dear flow cytometry group,

I have been unable to find literature pertaining to the unusual findings
in one of our cases and was wondering if any of you have ideas on a
diagnosis.  The patient is male, about 60 years old with supraclavicular
lymphadenopathy and possible history of cat scratch disease.  Flow cytometry
of lymph node cells shows that about 20% of the lymphocytes are CD3-CD4+,
CD3-CD8-, CD7-, CD2+ and CD5+.  These CD3-CD4+ cells are CD14- and bright
CD4+, unlike monocytes.  The remainder of the lymphocytes are a mix of T cells
with the usual markers and about 24% B lymphocytes with a normal kappa:lambda
ratio. About 60% of all lymphs are HLA-DR+ and 29% are expressing CD25.
Histology appears to show reactive morphology and no apparent Reed Sternberg
cells.

We suspect a lymphoma, but the morphology does not show an obvious abnormal
lymphoid population.  Has anyone seen this CD3-CD4+ phenotype in any reactive
conditions?  Is it necessary to send the sample out for T cell gene
rearrangement?

Thank you for your help,

Lucy Kimura
Flow Cytometry
Tripler Army Med. Ctr.
TAMC, Hawaii
lucille_h.kimura@tamc.chcs.amedd.army.mil



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