Turkish Journal of Pathology

Türk Patoloji Dergisi

Turkish Journal of Pathology

Turkish Journal of Pathology

E-pub Ahead Of Print

Case Series: Malignant Flower Cells in Peripheral Blood

Ursula Medeiros Araujo de MATOS 1, Wan Ying TAN 2, Kapil MELEVEEDU 2, Yara HAMADAH 1, Ritika VANKINA 2, Victoria FORBES 2, Dong CHEN 3

1 Department of Internal Medicine, University of Connecticut School of Medicine, FARMINGTON, USA
2 Department of Hematology and Oncology, Carole and Ray Neag Comprehensive Cancer Center, Connecticut Health Center, FARMINGTON, USA
3 Department of Pathology and Laboratory Medicine, University of Connecticut School of Medicine, FARMINGTON, USA

DOI: 10.5146/tjpath.2026.15185
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The presence of lymphoid cells with flower-like nuclei in peripheral blood is an uncommon morphologic finding, classically associated with Human T-lymphotropic virus type 1 (HTLV-1) infection related Adult T-cell Leukemia/Lymphoma (ATLL). However, similar cytologic features may be observed in other hematolymphoid malignancies. To describe cases of hematologic neoplasms presenting with flower cells in the peripheral blood and to highlight their broader diagnostic spectrum. We report a series of patients with distinct hematologic malignancies who demonstrated flower cells on peripheral blood smear, thereby expanding the morphologic differential beyond ATLL. Recognition that flower-like nuclear morphology may occur outside the context of ATLL is important for accurate diagnosis and underscores the need to consider a boarder range of hematolymphoid neoplasms in the differential.

Keywords : Malignant, Flower cells, ATLL, ALL