Part 2: Peripheral T-Cell Non-Hodgkin Lymphoma

Eric D. Jacobsen, MD

Dr. Jacobsen is an instructor in Medicine, Harvard Medical School; Attending Physician, Dana-Farber Cancer Institute, Boston, MA.

Question 2

A 46-year-old Caucasian woman with a 10-year history of osteoarthritis is referred to a hematologist for evaluation of neutropenia. She has been managed with nonsteroidal anti-inflammatory drugs (NSAID) as needed. A recent complete blood count (CBC) at her primary care physician’s office demonstrated a normal total white blood cell count but a neutrophil count of 310 cells/µL. Repeat CBC at the hematologist’s office confirms this finding. Her hemoglobin, hematocrit, and platelet count are normal. Her exam is notable for a spleen palpable 2 finger breadths below the left costal margin, but there is no palpable adenopathy. Her past medical history is notable for an episode of bronchitis 1 year ago but no other significant illnesses. She has lived her entire life in the northeastern United States. Which of the following is the most likely diagnosis?

  •  Adult T-cell leukemia/lymphoma, smoldering type (ATLL)
  •  NSAID-induced granulocytopenia
  •  T-cell prolymphocytic leukemia (T-PLL)
  •  T-cell large granular lymphocytic leukemia (T-LGL)
  •  Lyme disease

Updated 8/14/2010 • adb | Copyright ©2014 Turner White Communications