Unusual Presentation of T-cell Large Granular Lymphocytic Leukemia

Abstract

Large granular lymphocytic (LGL) leukemia is a rare chronic lymphoproliferative disorder that can arise from T- or natural killer-cell lineages. It is an indolent disease that typically occurs in the sixth decade of life. Most cases of T-cell LGL leukemia (T-LGL) are associated with autoimmune disorders. Patients with T-LGL are generally asymptomatic; however, they can present with symptoms related to neutropenia, infections, and autoimmune disorders. Here, we report two cases of T-LGL in which the patients presented with liver dysfunction.

Keywords: large granulocytic lymphocyte; leukemia; liver disease; liver dysfunction; t-lgl.

Figure 1. Case one: computed tomography of the abdomen and pelvis.

Findings compatible with cirrhotic liver with secondary features of portal hypertension such as splenomegaly, dilated portal and splenic veins, and minimal ascites

Figure 2. Case one: bone marrow flow cytometry.

P3-gated total lymphocytes in bone marrow aspirate show CD8+, CD57+, TCR beta+ abnormal T-cells consistent with T-cell large granular lymphocytic leukemia. P3: inositol 1,4,5-triphosphate receptor; SSC-A: side scatter parameter-A; TCR: T-cell receptor

Figure 3. Case two: computed tomography of the abdomen and pelvis.

Findings compatible with portal venous hypertension including splenomegaly and multiple collaterals.

Figure 4. Case two: bone marrow flow cytometry.

P3-gated total lymphocytes in bone marrow aspirate show CD8+, CD5 dim to negative, CD57+, TCR alpha/beta+ abnormal T-cells consistent with T-cell large granular lymphocytic leukemia. P3: inositol 1,4,5-triphosphate receptor; TCR: T-cell receptor