A CASE OF T-CELL PROLYMPHOCYTIC LEUKEMIA PRESENTING WITH VAGINAL BLEEDING
Recommended Citation
Nasser Z, Ramo A, Dabak V. A CASE OF T-CELL PROLYMPHOCYTIC LEUKEMIA PRESENTING WITH VAGINAL BLEEDING. 2022; :S389.
Document Type
Conference Proceeding
Publication Date
6-17-2022
Abstract
CASE: A 57-year-old female with no significant past medical history presented with a four-month history of lower extremity/facial swelling, vaginal bleeding, shortness of breath, and palpitations. Cardiac etiologies were ruled out. Complete blood count showed a WBC of 584 K/uL with absolute lymphocytes of 513, Hgb at 2.7g/dl, MCV 108.7, platelets 60. No previous baseline available for which this can be compared to. Folate, vitamin B12, haptoglobin and iron studies were normal. Viral studies including HTLV 1,2 antibody, hepatitis, EBV, and CMV were negative. CT of the abdomen/pelvis showed diffuse lymphadenopathy, splenomegaly, and uterine fibroids. Bone marrow biopsy showed T-cell prolymphocytic leukemia (T-PLL), 90% on the bone marrow aspirate smears and 90% on peripheral blood smear. Bone marrow was hypercellular with markedly diminished trilineage hematopoiesis. Flow cytometry on peripheral blood showed a predominant population of CD8+/TCRα/β+ monotypic T-cells. FISH studies were positive for inv (14) TRAD gene rearrangement. Endometrial biopsy was also consistent with T-PLL. Patient was recently started on Alemtuzumab therapy for T-PLL treatment with resolution of her symptoms including her vaginal bleeding. We present to you a rare case of T-PLL presenting with vaginal bleeding amongst other symptoms. IMPACT/DISCUSSION: T-cell prolymphocytic leukemia (T-PLL) is a rare, aggressive, mature T-cell neoplasm of lymphoid cells encompassing 2% of mature lymphocytic leukemias in middle-aged adults. Most patients present with little to no systemic B symptoms. On initial presentation, patients present with a leukocytosis (>100 K/uL), hepatosplenomegaly, generalized lymphadenopathy, anemia, and thrombocytopenia. Diagnosis involves evaluation of the bone marrow, flow cytometry, and cytogenetic testing which will also provide information on clinical staging and indication for treatment. Given the heterogenous nature of T-PLL, treatment is only proven to improve clinical outcomes in patients with active disease which includes constitutional symptoms, enlarging lymph nodes, organ/bone marrow failure, and leukocytosis. Organs that may be affected include skin, spleen, liver, and rarely the uterus (as in our patient's case, which has been scarcely reported). In our case, the patient's presenting symptoms, bone marrow and endometrial biopsy, flow cytometry, and FISH study results were consistent with the diagnosis of T-PLL. Given her active disease, she was deemed a candidate for alemtuzumab. After starting chemotherapy, there was significant improvement in the patient's symptomatology. CONCLUSION: -Active disease symptoms of T-PLL include constitutional symptoms, facial/peripheral edema, and vaginal bleeding. -While T-PLL presents with evidence of bone marrow failure, it is crucial to recognize other organ involvement (lungs, spleen, liver, uterus) and the respective associated symptoms as this will aide in early diagnosis and is an indication for treatment initiation.
First Page
S389
