Abstract
A case of lymphoma of T-cell derivation with aberrant expression of three B-cell lineage markers (CD19, CD20, and CD79a), which was diagnosed on a left axillary excision, is described. Immunohistochemical studies and flow cytometry analysis demonstrated neoplastic cells expressing CD3, CD19, CD20, and CD79a with absence of CD4, CD8, CD10, CD30, CD34, CD56, CD68, TDT, MPO, PAX-5, and surface immunoglobulin. Gene rearrangement studies performed on paraffin blocks demonstrated monoclonal T-cell receptor gamma chain rearrangement with no evidence of clonal heavy chain rearrangement. The neoplastic cells were negative for Epstein-Barr virus (EBV) or Human Herpes Virus 8 (HHV-8). At the time of diagnosis, the PET scan demonstrated hypermetabolic neoplastic cells involving the left axilla, bilateral internal jugular areas, mediastinum, right hilum, bilateral lungs, and spleen. However, bone marrow biopsy performed for hemolytic anemia revealed normocellular bone marrow with trilineage maturation. The patient had no evidence of immunodeficiency or infection with EBV or HHV-8. This is the first reported case of a mature T-cell lymphoma with aberrant expression of three B-cell lineage markers. The current report also highlights the need for molecular gene rearrangement studies to determine the precise lineage of ambiguous neoplastic clones.
Highlights
In vast majority of cases, T-cell lymphomas do not express B-cell markers
We present a case of a gamma clonal peripheral T-cell lymphoma expressing CD19, CD20, and CD79a in an individual with no evidence of immunodeficiency or infection with Epstein-Barr virus (EBV) or Human Herpes Virus 8 (HHV-8)
The current case report demonstrates the need to utilize genetic rearrangement studies to determine the precise lineage for neoplastic clones expressing biphenotypic markers by flow cytometry and immunohistochemistry
Summary
In vast majority of cases, T-cell lymphomas do not express B-cell markers. aberrant expression of one or two B-cell antigens has been documented. There are no cases reported in the literature of peripheral Tcell lymphomas expressing three B-cell immunophenotypic markers. Only one case report has described aberrant expression of only CD19 in mature T-cell lymphoma [3]. CD20 expression is diagnostic of B-cell lymphomas, hairy cell leukemia, melanoma, thymoma, and Hodgkin’s disease. Yao et al reported an aberrant expression of CD20 along with CD79a in the gamma clonal T-cell lymphoma. To our knowledge, this is the first case report of a peripheral mature T cell lymphoma expressing CD19, CD20, and CD79a B cell markers
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