As with any cancer, early diagnosis is critical, but never more so than with Hepatosplenic T-Cell Lymphoma.
Tommy experienced a delayed diagnosis which lost precious time. Tommy first displayed symptoms of blood irregularities in June of 2017 and was finally diagnosed with HSCTL in February of 2018. He perished within 8 months of his diagnosis. An earlier diagnosis and treatment, before the cancer was allowed to advance, may have given him time and options.
Our suggestion is that if the patient displays any signs of blood abnormalities, advocate for more aggressive laboratory tests, which are normally not administered until there is a "high index of clinical suspicion".
Hepatosplenic T-cell lymphoma may take a long time to diagnose, since many more common conditions may be considered first. The diagnosis is based on biopsy specimens of bone marrow, liver and/or spleen, and flow cytometry analysis. Review of biopsy material by an expert hematopathologist is recommended.
Bone marrow biopsies typically show hypercellular (extra space taken up by cells) marrow due to the atypical lymphoid cells, but the changes have been described as subtle. Belhadj and colleagues noted the following in their 2003 report on a series of 21 patients with HSTCL.
"This subtle involvement was not immediately recognized in six patients, leading to misdiagnoses of reactive hypercellular marrow in five patients and of chronic myelomonocytic leukemia in another patient with overt monocytosis at initial examination."
However, this research group also noted a distinguishing characteristically sinusal pattern of infiltration on routine bone marrow biopsy: “… a peculiar sinusal distribution of tumor cells that, at initial examination, is often subtle and therefore difficult to recognize without immunohistochemistry.”
Specialized laboratory tests such as flow cytometry and immunophenotyping of biopsy specimens are essential tools for diagnosis of HSTCL, but investigators note the importance of having a high index of clinical suspicion.
Physical exam and laboratory tests may also be suggestive. Findings on physical exam, including an enlarged spleen and liver, may be present. The complete blood count may show abnormalities such as thrombocytopenia (low platelet counts), anemia (low red blood cell counts), and leukopenia (low white blood cell counts). Liver tests may be essentially normal or show elevated enzymes.