Blood Res 2017; 52(4): 241-241  https://doi.org/10.5045/br.2017.52.4.241
Myelodysplastic syndrome with occult diffuse large B-cell lymphoma
Ja Young Lee1,*, and Hwa Jin Cho2

1Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea.

2Department of Pathology, Inje University College of Medicine, Busan, Korea.

Correspondence to: Ja Young Lee, M.D., Department of Laboratory Medicine, Busan Paik Hospital, Inje University, College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan 47392, Korea, liring@hanmail.net
Received: February 28, 2017; Revised: March 22, 2017; Accepted: June 15, 2017; Published online: December 26, 2017.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 

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A 71-year-old woman was admitted with dyspnea and generalized weakness. Twenty months prior, she had been diagnosed with myelodysplastic syndrome (MDS) with multilineage dysplasia. (A, Bone marrow (BM) aspiration, Wright-Giemsa stain, ×1,000). She was given eight cycles of azacitidine chemotherapy with regular follow-up. On admission, complete blood count revealed pancytopenia with a hemoglobin (Hb) level of 4.9 g/dL, white blood cell (WBC) count of 2.54×109/L (32% neutrophils, 43% lymphocytes, and 25% monocytes), and platelet count of 7×109/L. The BM examination showed hypercellularity with lymphoid hyperplasia. (B, BM aspiration, Wright-Giemsa stain, ×1,000, black arrow; C, BM biopsy, Hematoxylin and eosin stain, ×100). Flow cytometric analysis showed increased number of B lymphocytes expressing CD19, CD20 and CD22. Immunohistochemistry of the BM biopsy revealed neoplastic cells positive for CD20 (C, lower left inset) and MUM-1, and negative for CD23, bcl-2, bcl-6 and cyclin D1. This was consistent with BM involvement in diffuse large B-cell lymphoma (DLBCL). Cytogenetic analysis revealed that normal karyotype at initial BM was changed to trisomy 3 in 11/20 metaphases. Clonal IGH and IGK gene rearrangements were found in this specimen (D), and identically rearranged genes were found at initial diagnosis. Therefore, the patient was diagnosed with MDS with occult DLBCL.



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