Dorfman David M, Sadigh Sam
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA.
J Hematop. 2022 Apr 23;15(2):63-73. doi: 10.1007/s12308-022-00493-9. eCollection 2022 Jun.
Aggressive subtypes of non-Hodgkin lymphoma may uncommonly be referred to clinical oncologists for treatment of acute leukemia, due to an elevated or rapidly rising white blood cell count (WBC), with circulating neoplastic cells that morphologically resemble leukemic blasts seen in acute myeloid or lymphoblastic leukemia. We describe six cases of non-Hodgkin lymphoma that mimicked acute leukemia and were identified in the pathology records of the Brigham and Women's Hospital. The patients were older adults (mean age 70 years), who presented with leukocytosis (mean 79.7 × 10/L) with circulating neoplastic cells (mean 57%), which mimicked leukemic blasts, thrombocytopenia, and anemia (4/6 patients). In each case, immunophenotypic analysis identified a population of mature B cells or mature T cells. We identified 15 additional cases of non-Hodgkin lymphoma in the literature that mimicked acute leukemia; considering all 21 cases, 11 had an appearance of acute lymphoblastic leukemia, 4 had an appearance of acute monocytic leukemia, and 6 had an appearance of acute leukemia unable to be further categorized. In general, patients exhibited poor overall survival. These cases illustrate the importance of comprehensive immunophenotypic analysis in the initial evaluation of hematolymphoid neoplasms, and that occasional cases of non-Hodgkin lymphomas can resemble acute leukemia at initial presentation.
非霍奇金淋巴瘤的侵袭性亚型可能因白细胞计数（WBC）升高或迅速上升，伴有形态上类似于急性髓系白血病或淋巴细胞白血病中所见白血病原始细胞的循环肿瘤细胞，而罕见地被转诊至临床肿瘤学家处接受急性白血病的治疗。我们描述了6例模仿急性白血病的非霍奇金淋巴瘤病例，这些病例是在布莱根妇女医院的病理记录中发现的。患者为老年人（平均年龄70岁），表现为白细胞增多（平均79.7×10⁹/L），伴有循环肿瘤细胞（平均57%），这些细胞模仿白血病原始细胞、血小板减少和贫血（4/6例患者）。在每例病例中，免疫表型分析均鉴定出一群成熟B细胞或成熟T细胞。我们在文献中又发现了15例模仿急性白血病的非霍奇金淋巴瘤病例；综合所有21例病例来看，11例表现为急性淋巴细胞白血病，4例表现为急性单核细胞白血病，6例表现为无法进一步分类的急性白血病。总体而言，患者的总生存期较差。这些病例说明了全面免疫表型分析在血液淋巴系统肿瘤初始评估中的重要性，以及偶尔有非霍奇金淋巴瘤病例在初诊时可类似急性白血病。
