{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:00:27Z","timestamp":1790755227392,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Laboratory Analysis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>T\u2010cell lymphoblastic lymphoma (T\u2010LBL) and T\u2010cell acute lymphoblastic leukemia (T\u2010ALL) are considered a single biological entity, distinguished primarily by the extent of bone marrow infiltration. This distinction becomes diagnostically challenging in patients with borderline marrow blast counts and predominantly extramedullary disease, risking overclassification as leukemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We describe a 57\u2010year\u2010old man who presented with dyspnea and a large mediastinal mass causing superior vena cava syndrome, with pleural and pericardial effusions. Diagnostic workup included complete blood count and biochemistry, imaging, fine\u2010needle aspiration, core biopsy, pleural fluid cytology, multiparameter flow cytometry of pleural fluid and bone marrow, immunohistochemistry, and cerebrospinal fluid analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CBC and biochemistry were largely unremarkable aside from elevated LDH and CRP. Cytology and biopsy showed a diffuse blastoid lymphoid infiltrate. Pleural fluid flow cytometry identified an aberrant immature T\u2010cell population (cytoplasmic CD3+, CD1a+, CD2+, CD4+, CD5(dim)+, CD7+, CD8+, CD10+, TdT+; surface CD3\u2212, CD34\u2212, MPO\u2212), confirming cortical T\u2010ALL\/LBL and excluding B\u2010 and myeloid\u2010lineage differentiation. Bone marrow morphology suggested ~10% blasts, but flow cytometry detected only 3.8% CD34+ cells with a myeloid\u2010skewed, non\u2010T\u2010lymphoblastic phenotype, arguing against significant marrow involvement. The patient was classified as T\u2010LBL and treated per the GMALL protocol, achieving complete remission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Flow cytometry resolved a discrepancy between morphologic and immunophenotypic assessment of bone marrow involvement, preventing overclassification as T\u2010ALL. Multiparameter flow cytometry is essential for accurate lineage assignment and staging of precursor T\u2010lymphoid neoplasms in cytologic specimens and borderline marrow samples.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcla.70369","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T07:34:56Z","timestamp":1790753696000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flow Cytometry\u2010Guided Diagnosis of Cortical T\u2010Lymphoblastic Lymphoma Presenting With a Massive Mediastinal Mass and Borderline Bone Marrow Involvement"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0666-496X","authenticated-orcid":false,"given":"Chen","family":"Glait\u2010Santar","sequence":"first","affiliation":[{"name":"The Cellular Immunophenotyping Unit, Hematology Institute Tel Aviv Sourasky Medical Center  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3810-0218","authenticated-orcid":false,"given":"Yakir","family":"Moshe","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"},{"name":"Bone Marrow Transplantation Unit Tel Aviv Sourasky Medical Center  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itzhaki\u2010Alfia","family":"Ayelet","sequence":"additional","affiliation":[{"name":"Department of Pathology Tel Aviv Sourasky Medical Center  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5058-943X","authenticated-orcid":false,"given":"Ben\u2010Zion","family":"Katz","sequence":"additional","affiliation":[{"name":"The Cellular Immunophenotyping Unit, Hematology Institute Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1038\/s41375-022-01620-2","article-title":"The 5th Edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms","volume":"36","author":"Alaggio R.","year":"2022","journal-title":"Leukemia"},{"key":"e_1_2_8_3_1","first-page":"1229","article-title":"The 2022 International Consensus Classification of Lymphoid Neoplasms","volume":"140","author":"Khoury J. 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L.","year":"2011","journal-title":"Seminars in Hematology"},{"key":"e_1_2_8_7_1","first-page":"1","article-title":"The Role of Multiparameter Flow Cytometry in Hematologic Malignancies","volume":"9","author":"Kern W.","year":"2019","journal-title":"Blood Cancer Journal"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1038\/leu.2012.122","article-title":"EuroFlow Standardization of Flow Cytometric Immunophenotyping","volume":"26","author":"Kalina T.","year":"2012","journal-title":"Leukemia"},{"issue":"9","key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1038\/leu.2012.120","article-title":"EuroFlow Antibody Panels for Standardized n\u2010Dimensional Flow Cytometric Immunophenotyping of Normal, Reactive and Malignant Leukocytes","volume":"26","author":"Dongen J. 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