Indolent T-lymphoblastic proliferation (iT-LBP): a review of clinical and pathologic features and distinction from malignant T-lymphoblastic lymphoma

Adv Anat Pathol. 2013 May;20(3):137-40. doi: 10.1097/PAP.0b013e31828d17ec.

Abstract

In recent years, a new pathologic entity has emerged: indolent T-lymphoblastic proliferation (iT-LBP). iT-LBPs share immunophenotypic similarities with T-lymphoblastic lymphoma; however, T-lymphoblastic proliferations are clinically indolent, and unlike the malignant counterpart, these expansions of nonclonal terminal deoxynucleotidyl transferase (TdT)+ T cells do not require treatment. Here we review the clinical and pathologic features, which are required for an accurate diagnosis of an iT-LBP. We demonstrate specific criteria can be used to accurately diagnose iT-LBP, notably: (1) confluent groups of TdT+ T cells in a biopsy specimen, (2) relative preservation of surrounding normal lymphoid architecture, (3) TdT+ T cells without morphologic atypia, (4) absence of thymic epithelium, (5) nonclonal TdT+ T cells, (6) immunophenotype of developmentally normal immature thymic T cells, and (7) clinical evidence of indolence (follow-up >6 mo without progression).

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • DNA, Neoplasm / analysis
  • Diagnosis, Differential
  • Female
  • Humans
  • Hyperplasia
  • Immunophenotyping
  • Lymph Nodes / pathology*
  • Male
  • Middle Aged
  • Molecular Diagnostic Techniques
  • Precancerous Conditions
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / diagnosis*
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / immunology
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / therapy
  • Prognosis
  • T-Lymphocytes / pathology*

Substances

  • DNA, Neoplasm