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[REACTIVE/ATYPICAL LYMPHOCYTES]. Reactive or so-called “atypical” lymphocytes are generally seen in viral infections such as EBV or CMV mononucleosis or other viral infections but may also be seen in other reactive conditions. The cells are larger than a mature small lymphocyte and contain deep blue cytoplasm with peripheral accentuation. The nuclei are round to oval or indented with dense chromatin and sometimes with distinct nucleoli. The distinctive appearance of reactive lymphocytes is because of their larger size, deeply blue cytoplasm and “skirting” of cytoplasm around red blood cells.
[REACTIVE/ATYPICAL LYMPHOCYTES]. Note presence of very small azurophilic cytoplasmic granules (long arrow) and insinuation of cytoplasmic projections in between contiguous red blood cells. This “skirting” of cytoplasm is characteristic but not always present in reactive lymphocytes. The term “reactive” is preferred over “atypical” since atypical may also suggest something between normal and neoplastic lymphocytosis. Large lymphoma cells generally do not exhibit this much cytoplasmic skirting. Immunophenotypically, the cells are almost always CD8+ cytotoxic T-cells.
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