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<p>T-Large Granular Lymphocytic Leukemia (T-LGLL) and T-cell prolymphocytic leukemia (T-PLL) are rare forms of chronic lymphoproliferative disorders (CLPDs) with distinct clinical and morphological features. However, cases with overlapping clinical and morphological features pose a diagnostic challenge. Here, we report a case of a 57-year-old male with an indolent clinical course, high total leukocyte count, and atypical lymphoid cells with granular cytoplasm and prolymphocytoid nuclei on peripheral blood smear and intra-sinusoidal infiltration on trephine biopsy. Immunophenotypic analysis revealed CD4 positivity and loss of CD5 and CD7 expression. Despite overlapping features, a diagnosis of CD4-positive T-LGLL was made based on the overall clinical presentation, morphological features, and immunophenotypic profile.</p>

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Diagnostic Conundrums of T-CLPDs: A Case Report of a CD4-Positive T-LGLL with Overlapping Morphological Features of T-PLL

  • 期刊论文

  • 发表日期：

    2026年2月7日

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  • Subhajit Hajra,
  • Ankita Sen,
  • Pronati Gupta,
  • Basab Bagchi,
  • Abhishek Kumar,
  • Debirupa De,
  • Saunak Mitra Mustafi

摘要

T-Large Granular Lymphocytic Leukemia (T-LGLL) and T-cell prolymphocytic leukemia (T-PLL) are rare forms of chronic lymphoproliferative disorders (CLPDs) with distinct clinical and morphological features. However, cases with overlapping clinical and morphological features pose a diagnostic challenge. Here, we report a case of a 57-year-old male with an indolent clinical course, high total leukocyte count, and atypical lymphoid cells with granular cytoplasm and prolymphocytoid nuclei on peripheral blood smear and intra-sinusoidal infiltration on trephine biopsy. Immunophenotypic analysis revealed CD4 positivity and loss of CD5 and CD7 expression. Despite overlapping features, a diagnosis of CD4-positive T-LGLL was made based on the overall clinical presentation, morphological features, and immunophenotypic profile.