Light Scatter	CD45/14	CD5/20

CD3/23	CD7/1A	CD4/8

CD34/10	CD19/Kappa	CD19/Lambda

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• The bone marrow light scatter demonstrates at least two distinct populations of cells. The small to intermediate sized cells are the majority of cells with the large cells being smaller in number.  This large population of cells make up approximately 15% of the total nucleated cells. This matches what was seen in the bone marrow smear (see light scatter)(see bone marrow smear). The data presented above was for the small to intermediate cells (R1).

 
• The CD45/14 contour plot reveals that all of the cells within the set light scatter gates are high intensity CD45 positive (a characteristic of lymphocytes. There are no monocytes/promonocytes present (see CD45/14).

 
• The CD5/20 contour plot reveals that all of the cells express CD5 (Tcell) and not CD20 (B cell). Therefore, virtually all of the cells within this gate are T cells (see CD5/20).

 
• The CD3/23 contour plot again confirms that there are no B cells and only T cells. The T cells must be fairly mature since CD3 (T cell receptor) is expressed. At this point, a B cell immunodeficiency (by lab results only) is a possibility as well as a T cell leukemia/lymphoma. (see CD3/CD23)

 
• The CD7/1A contour plot confirms that the T cells are not immature thymocytes which would be CD1A positive. They are not positive for CD1A but are positive for CD7 (pan T cell) marker. (see CD7/1A).

 
• The CD4/8 contour plot suggest that these cells are clonal for CD4, since there is an increase in the CD4 to CD8 cell ratio from 2:1 to nearly 9:1.  There are very few conditions where such high increases in the CD4:CD8 ratio are seen. In reactive processes the normal increases seen in the CD4:CD8 ratio rarely are this high.  Occasionally, such increases have been noted in patients with Hogkin's disease. The most likely explaination for this increase is a T cell leukemia, which fits the clinical picture of skin rash (T cell leukemia/lymphomas commonly invade the skin). (see CD4/CD8)

 
• The CD34/10 plot demonstrates no reactivity to either CD34 or CD10  which is the result expected for a mature T cell. (see CD34/10).

 
• Finally the CD19/kappa and CD19/lambda contour plots again demonstrate absolutely no B cells present.  (see CD19/Kappa, CD19/lambda).

 
• All of these results taken together with the patients history are highly suspicious for a T cell lymphoproliferative disease (most likely Sezary) since there is skin involvement and the great majority are mature CD4 positive T cells. However, since there are some CD8 cells present, these results are not diagnostic. However, if one looks at the minor population of large cells (R2 region by light scatter) for expression of CD4 and CD8, the results become diagnostic (see CD4/CD8 contour plot of region 2 below) and exclude reactive cells due to the appearent monoclonality of the cells present (CD4 to CD8 ratio 95:1).

 

Region 2 Large Cells

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