Dept of Medicine

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Dept of Medicine Pathology CWM Hospital Fiji
School of MedicineWeekly CPC Meeting
10 April 2003 22 Year Fijian Female with
Fever (ALL/NHL)
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Clinical Details

• 22y Fijian Lady
• Presented with fever, weakness,
• Abdominal distension huge spleen
• Lymphadenopathy.
• CBC very high WBC count 400,000
• Lymphnode biopsy.

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Lymphnode Biopsy

• Biopsy shows lymphnode replaced by homogenous
  dense tissue. (no follicle archetecture seen)
• Capsule appears intact.

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Lymphnode Biopsy

• Biopsy shows lymphnode replaced by homogenous
  dense tissue. (no follicle archetecture seen)
• Capsule appears intact.

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Lymphnode Biopsy

• Biopsy shows lymphnode replaced by homogenous
  dense tissue. (no follicle archetecture seen)

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Lymphnode Biopsy

• Tumor cells how uniformly small, large nucleus
  filling the cell, scanty pale cytoplasm
• Plenty of mitotic figures suggesting Rapid growth

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Lymphnode Biopsy

• Some places tumor cells fill into blood vessels
  and lymphatic channels.

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Lymphnode Biopsy

• Some places tumor cells fill into blood vessels
  and lymphatic channels.

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Lymphnode Biopsy

• Large irregular nucleus
• Abnormal mitotic figures
• Scanty pale cytoplasm. (very little cytoplasm is
  visible, cells appear as just clusters of nuclii)

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Discussion

• This case has been provisionally called as
  Lymphoma/Leukemia syndrome. Lymphoblastic type.
• Marked spleen and lymphnode enlargement feature
  of lymphoma.
• Very high WBC count abnormal blast cells
  feature of leukemia.
• No thrombocytopenia.
• However further studies on bone marrow and cell
  marker studies are required to confirm.