Adult T-cell leukemia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]

Overview

Adult T-cell leukemia must be differentiated from other diseases that cause weight loss, night sweats, hepatosplenomegaly, and palpable lymph nodes, such as hairy cell leukaemia, prolymphocytic leukaemia, follicular lymphoma, and mantle cell lymphoma.

Differentiating Adult T-cell Leukemia from other Diseases

• Adult T-cell leukemia must be differentiated from other diseases that cause weight loss, night sweats, hepatosplenomegaly, and palpable lymph nodes, such as hairy cell leukaemia, prolymphocytic leukaemia, follicular lymphoma, and mantle cell lymphoma.
• Based on the expression of cell surface markers, the table below differentiates adult T-cell leukemia from other diseases that cause similar clinical presentations:

Differential Diagnosis	Surface Immunoglobulin	CD5	CD22/FMC7	CD23	CD79b	CD103
Chronic lymphocytic leukemia	Weakly positive	Positive	Negative	Positive	Negative	Positive/Negative
Prolymphocytic leukemia	Strongly positive	Negative	Positive	Negative	Positive	Negative
Hairy cell leukemia	Strongly positive	Negative	Positive	Negative	Positive/Negative	Positive
Mantle cell lymphoma	Positive	Positive	Strongly positive	Negative	Strongly positive	Negative
Follicular lymphoma	Strongly positive	Negative	Positive	Negative	Strongly positive	Negative

• Adult T-cell leukemia must also be differentiated from other causes of fever, hepatosplenomegaly, and lymph node swelling such as:

• Splenic marginal zone lymphoma
• Nodal marginal zone lymphoma
• Lymphoplasmacytic lymphoma
• Sézary syndrome