A 68-year-old male patient was admitted to the hospital because of generalized lymphadenopathy and splenomegaly. Peripheral blood examinations revealed the hemoglobin 10.1g/dl, the platelet count 38,000/mm3 and the white blood cell count 20,800/mm3 with 86.5% mature lymphocytes. From these findings, he was suspected to have chronic lymphocytic leukemia. The examinations of surface markers on the lymphocytes revealed they were of T-cell origin. The histology of cervical and inguinal lymph node biopsy specimens, however, showed that there were a lot of aggregates of epithelioid and reticulum cells among diffuse infiltration of mature lymphocytes and large lymphoblastoid cells. These findings indicated Lennert's lymphoma rather than CLL.
On autopsy, these epithelioid cells disappeared and only mature lymphocytes remained in all lymph nodes examined. From these autopsy findings and absolute lymphocytosis in the peripheral blood, the final diagnosis was T-cell CLL.
