Table 2.

Patient 2 pathological findings, by site.

	Site (days from original diagnosis)	Diagnosis	Morphology	IHC (T-cell population of interest)	Flow (T-cell population of interest)	Gene rearrangements		Peripheral blood CBC with 100-cell differential count (%)∗		Cytogenetics
5/2009	Mediastinal mass	T-cell ALL	Monotonous population of immature lymphoid cells with high N:C ratio, round to oval nuclei, mild nuclear irregularity, and scant cytoplasm	Positive: TdT (90%)	Positive: CD2, CD3, CD5 (d), CD7, CD4, CD8, CD45, CD10 Negative: CD20, EpCAM, Cytokeratin	TβA	Germline	WBCa	6.4
						TβB	Germline	Hemoglobinb	12.8
						TβC	Germline	MCVc	87.2
						TγA	Germline	Plateletsa	209
						TγB	185.23, 193.82	Lymphocytes	18.7
								Atypical lymphocytes	0
								Blasts	0
	Pleural fluid 17 days	T-cell ALL	Immature lymphoid blasts	Positive: CD3, CD4, CD8, TdT, CD99 Negative: CD79a	np	np		nc		No mitotic activity
	Right iliac crest 18 days	T-cell ALL	Sheets of lymphoblasts with high N:C ratio, immature chromatin, visible nucleoli, scant cytoplasm with occasional cytoplasmic vacuoles	np	Positive: CD45 (d), cyCD3, CD7, CD4, CD8, TdT (d), CD117, CD10 Negative: CD20, CD34; loss of surface CD3 and CD5	np		WBCa	9.94
								Hemoglobinb	13.9
								MCVc	86.2
								Plateletsa	262
								Lymphocytes	Few
								Atypical lymphocytes	22
								Blasts	0
9/2009	Left iliac crest 131 days	Normocellular marrow with NEM	nc	nc	nc	Germline		nc		Normal
3/2013	Right iliac crest† 1417 days	Normocellular marrow with NEM	nc	np	nc	TβA	262.3	WBCa	6.39
						TβB	261.10, 266.54	Hemoglobinb	1.7
						TβC	188.74	MCVc	90.6
						TγA	Germline	Plateletsa	165
						TγB	174.32	Lymphocytes	19.7
								Atypical lymphocytes	0
								Blasts	0
	Pleural fluid 1419 days	PTCL, NOS with 75% large T-cells	Abundant large lymphoid cells with condensed chromatin, markedly irregular nuclear contours, frequent horseshoe-shaped nuclei, occasional binucleation, inconspicuous nucleoli, moderate-to-abundant pale blue cytoplasm, and cytoplasmic azurophilic granules	np	Positive: CD3c, CD8, CD45 Negative: CD3, CD7, CD4, TdT, CD117, CD20, CD34, CD56	TβA	259.6 (+/−)	WBCa	6.12	SNP ARRAY
						TβB	252.79, 272.24	Hemoglobinb	10.4
						TβC	326.3	MCVc	91.5
						TγA	208.3, 216.77	Plateletsa	190
						TγB	Germline	Lymphocytes	19.6
								Atypical lymphocytes	0
								Blasts	0
3/2013	Left chest wall mass 1419 days	PTCL, NOS∗∗	Skeletal muscle extensively involved by a diffuse infiltrate of large lymphoid cells with granular chromatin, marked nuclear pleomorphism, markedly irregular nuclear contours, occasional horseshoe-shaped nuclei, and occasional conspicuous nucleoli	Positive: CD2, CD3, CD8 (b), ki67 (80%) Negative: CD5, CD7, CD4, TdT, CD15, CD20, CD30, CD34, CD56, pan-keratin, PAX5, EBV-LMP, EBER	np	np		nc
	Left flank mass	PTCL, NOS	Large lymphoid cells with granular chromatin, marked nuclear pleomorphism, markedly irregular nuclear contours, occasional horseshoe-shaped nuclei, occasional conspicuous nucleoli, moderate pale eosinophilic cytoplasm, and abundant cytotoxic granules	Positive: CD3 (b), granzyme-B Negative: CD5, TdT, CD20, CD30, CD34, ALK-1, CD1a, myeloperoxidase, EBER ISH	Not representative

Note: (b) bright; (d) dim; (f) focal; (s) positive in subset; +/− equivocal. NEM, no evidence of malignancy; nc, noncontributory; nd, nondiagnostic due to insufficient specimen; np, not performed. ^aIn k/μL; ^bin g/dL; ^cin fL. ^∗Manual differential used when available; otherwise, automated impedance counts were utilized. ^†The IHC profile is from a chest wall mass biopsy taken on the same day. This biopsy had a dense atypical lymphocytic infiltrate. ^∗∗Flow photocytometry demonstrated a 5% population of small T-cells. Limited material hindered full evaluation.