Diagnosis of a T-lineage acute lymphoblastic leukemia through digitalized cell analysis of the pleural effusion

Benedetta Peruzzi,¹ Ilaria Cutini,² Anna Maria Grazia Gelli,¹ Tommaso Rondelli,¹ Marinella Statello,¹ Sara Bencini,² Francesco Mannelli,² Roberto Caporale,¹ Alberto Bosi,² Alessandra Fanelli<sup>1

1</sup>General Laboratory Unit (Microscopy and Clinical Cytometry Unit), ²Hematology Unit, Azienda Ospedaliero–Universitaria Careggi, Firenze, Italy

Introduction: Pleural effusion as the first clinical manifestation of acute lymphoblastic leukemia (ALL) is a relatively rare event. An early and accurate diagnosis of this clinical picture is very important for adequate patient management.
Case presentation: We report the atypical onset of T-lineage ALL in a 31-year-old man. The patient was admitted to the emergency room due to lung failure; at that moment, the patient's initial blood count was normal; the chest X-ray radiography showed a massive pleural effusion and a thoracentesis was carried out. Routine investigations performed on the pleural fluid using a new technology system and digitalized cell analysis demonstrated infiltration by immature cells. Therefore, bone marrow aspirate and flow cytometry analyses were performed, leading to the diagnosis of T-lineage ALL. A cord blood transplantation procedure was performed at the first hematological remission following chemotherapy regimens. The patient died of septic shock.
Conclusion: The case we reported underlines the usefulness of using automated instruments to identify abnormal lymphoid cells in body fluids.

Keywords: pleural effusion, digital morphology, leukemia