Aberrant Expression of B-Cell Markers in T-Cell Lymphoblastic Lymphoma in Pleural Fluid - Abstract
T-cell lymphoblastic lymphoma is an aggressive malignancy which accounts for 85% of all the lymphoblastic lymphomas. It has a male preponderance and manifests in young adulthood and adolescent age group. The patients typically present with pleural effusion, chest pain, and respiratory distress and in rare cases a vena cava syndrome can be encountered. We present the case of an 11-year-old female patient who presented with fever, cough, weight loss, chest pain and breathing difficulty for a month prior to admission. On examination, the patient had unilateral pleural effusion (PE). A work up of tuberculosis was started and pleural fluid analysis was done. The cytology however, showed the presence of lymphoblasts on smears. Flow cytometric analysis revealed T-cell lymphoblasts with aberrant expression of B-cell markers. A thoracic computed tomography (CT) scan was performed later and showed the presence of an anterior mediastinal mass measuring 7x10x3 cms. The patient also had un resolving pericardial effusion. A cardiocentesis was performed which showed similar findings. The patient was then shifted to the hemato-oncology ward for induction chemotherapy. T-cell lymphoblastic lymphomas are usually hard to diagnose considering the fact that the symptoms are often vague. The expression of aberrant B-cell markers made the diagnosis a challenge. It is essential to establish the diagnosis without delay and start appropriate chemotherapeutic treatment.