An 82-year-old woman was admitted for cardiac insufficiency associated with obesity, renal insufficiency, and refractory atrial fibrillation. The patient had no history of hematological malignancies. Clinical examination revealed no lymphadenopathy, tumoral syndrome, or weight loss. Hematological tests showed the following: platelets, 173×109/L; hemoglobin, 10.3 g/dL; white blood cells, 10.5×109/L; and lymphocytes, 5.60×109/L. Cytological examination of blood smear indicated the presence of small lymphocytes with very mature chromatin, regular nuclei, and multiple intracytoplasmic sharp vacuoles, accounting for 41% of the total lymphocytes, as determined by manual differential white blood cell count (Panel
Vacuoles in lymphocytes have been reported in lysosomal storage diseases and neoplastic disorders; moreover, they are physiologically present in T and natural killer lymphocytes. Although vacuoles are more or less specific, they deserve attention as they can offer valuable insights.