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To present a case report of an 83-year-old female with underlying dementia and a 1–2 month history of left upper quadrant pain. This report includes a review of the morphology of T-cell prolymphocytic leukemia (PLL), diagnosis, and the treatment options considered.T-cell PLL is a rare blood disorder that represents a very small number of all chronic leukemias. An extensive review of scientific literature related to the cell morphology and pathology of this disease, as well as clinical trials of treatment options provided the background for this case report.A diagnosis of T-cell PLL was made after a computed tomography scan of the abdomen confirmed splenomegaly and a bone marrow biopsy showed a hypercellular marrow infiltrated with numerous small lymphocytes, consistent with this disease. Currently, there is no optimal treatment for T-cell PLL, but alemtuzumab has shown success with extending survival 1–3 years.This case presented several ethical and practical challenges for this patient and her family in making a decision for chemotherapy treatment. This case underscores the need for the physicians and nurse practitioners to establish a collaborative relationship with patient, family, and other care providers when advocating for or against treatment.