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Test Findings
 
 

Atypical Lymphocytes

 
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Overview

The term atypical lymphocyte is used to refer to any abnormal lymphocyte that does not appear reactive. The presence of such cells in the peripheral blood suggests a neoplastic process, such as a lymphoid leukaemia or the leukaemic phase of lymphoma. These cells may be difficult to distinguish on morphological examination.
  • Causes of Atypical Lymphocytes

  • Mature B cell leukaemias - CLL, B cell prolymphocytic leukaemia, hairy cell leukaemia, hairy cell leukaemia variant
  • Leukaemic phase of B cell lymphomas - follicular lymphoma, mantle cell lymphoma, splenic marginal zone lymphoma, diffuse large B cell lymphoma, burkitt lymphoma
  • Mature T cell neoplasms - T cell prolymphocytic leukaemia, T cell large granular lymphocytic leukaemia, adult T cell leukaemia / lymphoma, Sezary syndrome, anaplastic large cell lymphoma
  • Interpretation

  • Chronic lymphocytic leukaemia - large numbers of small mature lymphocyes with smudge cells
  • Hairy cell leukaemia - medium-sized cells with 'hairy' projections
  • Follicular lymphoma - small cells with deeply clefted nuclei
  • Splenic marginal zone lymphoma - 'polar' projections from two ends of the cell
  • Diffuse large B cell lymphoma - large cells with cytoplasmic vacuoles
  • Burkitt lymphoma - deeply basophilic cytoplasm with vacuoles
  • T large granular lymphocytic leukaemia - medium-sized cells with the nucleus to one side of the cell, and azurophilic granules
  • Sezary syndrome - 'cerebriform' nucleus (looks like a brain)
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