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An 8 1 -year-old male patien t presen ts with a LJ-mon th history of progressive purple skin lesions on his face, trunk, and lower extremities. Com plete blood count shows leukocyte count LJ,LJOO/,LLL. hemoglobin 1 0 .6 g/dl, and platelet count 1 88,000/,LLL. LDH was elevated at LJ82 U/L. The peripheral blood smear is shown below.
Flow cytometry of the peripheral blood shows expression of CD2, CDS, CD43, and CD 56 and lack of expression for CD3, CD4, CD16, and CD 57. These results are most consistent with what type of cell population?
- Plasma cells
- Natural killer (NK) cells
- Myeloid blasts
- Lymphoid blasts
Medicine
B. CD2+, surface CD3-, and CD 56+ is consistent with an NK-cell population. The periph-eral blood shows medium and large cells with basophilic cytoplasm, and fine chromation and a nucleolus in the large cell; azurophilic granules can be observed in the cytoplasm. The patient devel-oped progressive skin lesions with a rapid increase in leukocytes, with large immature cells and wors-ening thrombocytopenia and anemia. A diagnosis of aggressive natural killer cell leukemia was established.
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