#00063381

A 58-year-old male presented with 3 weeks history of progressive shortness of breath. Total leukocyte count was 133 x 10^9/L. Peripheral blood smear showed many atypical lymphocytes (not shown). Bone marrow smear shows excess of medium sized lymphocytes with convoluted nuclear contours.  Bone marrow flow shows abnormal CD4+ T cells population account for 84% total intact cells. They are positive for CD2, CD5, equivocal for CD25, and negative for CD7, TdT. FISH and molecular karyotyping detected a complex karyotype with gains, losses and chromothripsis. Clonal T cell receptor beta and gamma chain gene rearrangements were postive. Serology for HTLV-1 was positive and serum calcium was 4.3 mmol/L. PET/CT confirmed FDG avid nodes above and below the diaphragm. Diagnosis of Adult T Cell Leukaemia-Lymphoma (ATLL) was made.