Mantle cell lymphoma
Peripheral T cell lymphoma
Anaplastic large cell lymphoma
Adult T cell leukemia/lymphoma
The most likely diagnosis is Adult T cell leukemia/lymphoma.
The peripheral smear given above shows tumor cells with multilobulated nuclei (“clover leaf” or “flower” cells).
This is a characteristic of Adult T-Cell Leukemia/Lymphoma.
Adult T-Cell Leukemia/Lymphoma (CD4+)
o Observed in adults infected by human T cell leukemia retrovirus type 1 (HTLV-1)
o Skin lesions, generalized lymphadenopathy, hepatosplenomegaly, peripheral blood lymphocytosis, and hypercalcemia
o Cells with multilobulated nuclei (“clover leaf” or “flower” cells)
o A rapidly progressive disease that is fatal within months to 1 year
Note: Tropical spastic paraparesis is another manifestation of HTLV-1 infection.