Korean J Lab Med.  2009 Jun;29(3):194-198. 10.3343/kjlm.2009.29.3.194.

A Case of Natural Killer Cell Leukemia Misdiagnosed as Tuberculous Lymphadenopathy

• Lee AJ
• Kim SG
• Jeon CH
• Suh HS
• Yoon GS
• Seo AN

• KMID: 1096969
• DOI: http://doi.org/10.3343/kjlm.2009.29.3.194

Abstract

Natural killer (NK) cell neoplasms are a group of rare but highly malignant tumors. We report here one case of NK cell leukemia. A 54-yr-old woman presented with a 2-month history of progressive left neck mass. Based on the positive result of tissue PCR for Mycobacterium tuberculosis, she was at first diagnosed with tuberculous lymphadenopathy. After two weeks, she developed generalized lymphadenopathy, hepatosplenomegaly, fever and anemia. Subsequent evaluation was performed including bone marrow aspiration and biopsy. Peripheral blood smear showed leukoerythroblastic features with 31% blasts. Bone marrow was packed with agranular blastoid cells, which were periodic acid-Schiff (PAS) positive and myeloperoxidase (MPO) negative. Immunophenotyping showed that these cells were positive for CD45 and HLA-DR, whereas negative for CD3, CD5, CD7, CD10, CD13, CD14, CD19, CD20, CD22, CD33, CD34, and CD61. Because of the absence of the markers of T-cell, B-cell, and myeloid lineage-specific antigens, we added CD16/56 for the immunophenotyping and the blasts were positive (94%). The tumor cells of biopsied lymph node were only positive for CD56, consistent with NK cell lymphoma. Epstein-Barr virus (EBV) was not detected by RNA in situ hybridization. Culture for M. tuberculosis was negative. Thus this patient was diagnosed with blastic NK cell lymphoma/leukemia involving bone marrow and lymph node.

Keyword

Natural killer cell; Natural killer cell leukemia; Tuberculosis; Polymerase chain reaction

MeSH Terms

Antigens, CD45/metabolism
Bone Marrow/pathology
Female
HLA-DR Antigens/metabolism
Humans
Killer Cells, Natural/immunology/*pathology
Leukemia/*diagnosis/immunology/pathology
Middle Aged
Tuberculosis, Lymph Node/diagnosis

Figure

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  Fig. 1. Peripheral blood smear shows atypical blastoid cells (Wright stain, ×400).

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  Fig. 2. Tumor cells in bone marrow aspirate smear show lymphoblastoid features with high nuclear cytoplasmic ratio and inconspicuous nucleoli. Intracytoplasmic azurophilic granules are absent (Wright stain, ×400).

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  Fig. 3. Blasts are periodic acid-Schiff (PAS) positive (×1,000).

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  Fig. 4. Immunohistochemical staining of lymph node shows neoplastic cells with expression of the natural killer (NK) cell antigen, CD56 (×400).

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