A Rare Presentation of T-cell Prolymphocytic Leukemia With Abnormal Uterine Bleeding

T-cell prolymphocytic leukemia (T-PLL) is a rare and clinically aggressive T-cell neoplasm, which is composed of lymphoid cells that are of post-thymic T-cell origin. This is a case of a 57-year-old female with no significant medical history, who presented with a 4-month history of facial swelling, peripheral edema, dyspnea, palpitations, and abnormal uterine bleeding (AUB). A complete blood count demonstrated lymphocytosis, and a computed tomography (CT) scan of the abdomen and pelvis showed diffuse lymphadenopathy, splenomegaly, and uterine fibroids. A bone marrow biopsy confirmed the presence of T-PLL with a subsequent endometrial biopsy showing atypical lymphoid proliferation consistent with T-PLL. The patient was started on alemtuzumab for T-PLL treatment. This case demonstrates a rare presentation of T-PLL with endometrial involvement, which may have contributed to the patient's postmenopausal uterine bleeding. Recognition and evaluation of disease infiltration require prompt clinical assessment to reduce the morbidity and mortality associated with T-PLL.