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.
A 52-year-old man is referred to a hematologist for management of lymphocytosis. He presented to his primary care physician complaining of fevers, night sweats, and hepatosplenomegaly and was found to have a white blood cell count of 86,000 cells/µL with 92% lymphocytes on differential. His hemoglobin is low at 9.4 g/dL and his platelet count is low at 89,000/µL. Flow cytometry from the peripheral blood reveals a population of cells positive for CD2, CD3, CD4, CD5, and CD 7 and negative for CD8 and CD20. Cytogenetic analysis reveals inversion 14. His serum calcium and creatinine levels are normal. He has an elevated lactate dehydrogenase (LDH) as well as elevated aspartate aminotransferase and alanine aminotransferase. There is no palpable adenopathy. His past medical history is notable for irritable bowel syndrome, hypertension, and diabetes. What is the most likely diagnosis?