Namrata P Awasthi

Abstract

T-cell lymphoblastic lymphoma often presents as a large mediastinal mass in the anterior mediastinum with shortness of breath as chief complaint. We, put forward a case of T-LBL, presenting with obstructive jaundice and, later developing pleural effusion. Diagnosis was clinched by Flow Cytometry (FCM) performed on the pleural fluid, which revealed, neoplastic lymphoid cells; suggesting T-cell Lymphoproliferative disorder.Bone marrow examination and immunohistochemistry revealed CD3+, TDT+, CD10+, CD34- and CD20- blasts. Thus, diagnosis of T-ALL/LBL was rendered. Clinicians should be mindful that TALL/LBL can uniquely present with obstructive jaundice, proffering serious diagnostic dilemma. FCM should be attempted on any available body fluids/effusions, in appropriate clinical settings, as it can contribute substantially, in making a rapid diagnosis and, initiating early therapy. Key Messages: 1. Leukemia/lymphoma should be considered in the differential diagnoses, when the initial work-up for obstructive jaundice, is inconclusive; 2. FCM can be performed on any fluid/effusion sample for hematolymphoid neoplasm and can aid in making a rapid diagnosis.   Keywords: T­Lymphoblastic leukemia/lymphoma, Obstructive jaundice, Pleural effusion, Flow cytometry

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