Blood Res 2018; 53(3):
Published online September 28, 2018
https://doi.org/10.5045/br.2018.53.3.256
© The Korean Society of Hematology
1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
2Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea.
Correspondence to : Correspondence to Ji Hyun Lee. Department of Internal Medicine, Dong-A University College of Medicine, Daeshingongwonro 26, Seo-gu, Busan 49201, Korea. hidrleejh@dau.ac.kr
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.
A 37-year old female presented with a two-week history of neck and pelvic area pain, fever, and chills. On physical examination, the spleen was palpable 10 cm below the lower costal margin on the left mid-clavicular line. The liver and lymph nodes were not palpable.
Initial blood test revealed elevated white blood cell (WBC) count with blasts (WBC 287.520×109/L; segmented neutrophil 32%; metamyelocyte 2%; myelocyte 13%; eosinophil 2%; basophil 1%; blast 13%; Hb 9.6 g/dL; platelets 187×109/L). Prothrombin time (PT) and activated partial prothrombin time (aPTT) were in the normal range (PT 13.5 sec; aPTT 25.5 sec), and fibrinogen was slightly increased (467.5 mg/dL).
A bone marrow (BM) aspiration and biopsy showed markedly hypercellular marrow and increased blasts (about 23.8% of all nucleated cells) with predominantly lymphoblast morphology with scant cytoplasm without Auer rods (Fig. 1A). Special staining showed negativity to all of MPO, Sudan black B, and specific and nonspecific esterases and periodic acid-Schiff staining. On immunophenotyping, blast cells expressed myeloid (cytoplasmic MPO 54.58%, CD13 77.94%, CD33 75.4%), B-lymphoid (CD10 26.87%, CD19 83.94%), and stem cell markers (CD34 3.11%, CD71 53.7%). Chromosomal analysis by G-banding showed 46,XX,t(9;22) (q34;q11) in 23 cells among the 25 metaphase cells analyzed (Fig. 1B). The FISH signals from Vysis indicated abnormal
The patient had leptomeningeal seeding metastasis at diagnosis by cerebrospinal fluid (CSF) analysis. Meanwhile, the patient received leukocyte reduction by leukapheresis from the day of admission. Treatment was started on admission day 8 with induction chemotherapy of hyperCVAD [cyclophosphamide 300 mg/m2 days 1–3; vincristine 1.4 mg/m2 (max. 2 mg) days 4,11; adriamycin 50 mg/m2 day 4; dexamethasone 40 mg days 1–4, 11–14] in combination with Imatinib 600 mg. On induction chemotherapy day 3, the patient showed profuse epistaxis, due to hypofibrinogenemia (platelet 90×109/L, fibrinogen 17 mg/dL). All-trans retinoic acid (ATRA) 45 mg/m2 was added on induction day 7 to the treatment until confirmation of negative
To date, cytogenetic abnormality of t(15;17) has been noted in two BAL cases. One BAL case had FAB ALL-L2 morphology with immunophenotypic pattern showing MPO 53%, CD10 83%, and CD19 87%, a cytogenetic result of t(15;17), +8, and a
Coexistence of
Among the MPAL patients, t(9;22)/
To the best of our knowledge, this is the first case of MPAL with t(9;22) with cryptic expression of
Bone marrow aspiration smear shows lymphoblasts with scanty cytoplasms, lacking Auer rods and granules (Wright-Giemsa stain, ×1,000)
Abbreviations: M, nucleic acid marked ladder; IC, internal control.
Table 1 Summary of published cases of co-expressing BCR-ABL1 and
Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; ATRA, all trans-retinoid acid; Ara-C, cytosine arabinoside; BCR-ABL1, breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1; CR, complete remission; Dauno, daunorubicin; F, female; FAB, French-American-British; Hb, haemoglobin; Ida, idarubicin; M, male; PCR, polymerase chain reaction; PLT, platelet; PML-RARα, promyelocytic leukemia-retinoid acid receptor; WBC, white blood cell.
Blood Res 2018; 53(3): 256-260
Published online September 28, 2018 https://doi.org/10.5045/br.2018.53.3.256
Copyright © The Korean Society of Hematology.
Seok Jae Huh1, Sung-Hyun Kim1, Hyo-Jin Kim1, Jin Yeong Han2, Hyeonho Lim2, and Ji Hyun Lee1*
1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
2Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea.
Correspondence to:Correspondence to Ji Hyun Lee. Department of Internal Medicine, Dong-A University College of Medicine, Daeshingongwonro 26, Seo-gu, Busan 49201, Korea. hidrleejh@dau.ac.kr
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.
A 37-year old female presented with a two-week history of neck and pelvic area pain, fever, and chills. On physical examination, the spleen was palpable 10 cm below the lower costal margin on the left mid-clavicular line. The liver and lymph nodes were not palpable.
Initial blood test revealed elevated white blood cell (WBC) count with blasts (WBC 287.520×109/L; segmented neutrophil 32%; metamyelocyte 2%; myelocyte 13%; eosinophil 2%; basophil 1%; blast 13%; Hb 9.6 g/dL; platelets 187×109/L). Prothrombin time (PT) and activated partial prothrombin time (aPTT) were in the normal range (PT 13.5 sec; aPTT 25.5 sec), and fibrinogen was slightly increased (467.5 mg/dL).
A bone marrow (BM) aspiration and biopsy showed markedly hypercellular marrow and increased blasts (about 23.8% of all nucleated cells) with predominantly lymphoblast morphology with scant cytoplasm without Auer rods (Fig. 1A). Special staining showed negativity to all of MPO, Sudan black B, and specific and nonspecific esterases and periodic acid-Schiff staining. On immunophenotyping, blast cells expressed myeloid (cytoplasmic MPO 54.58%, CD13 77.94%, CD33 75.4%), B-lymphoid (CD10 26.87%, CD19 83.94%), and stem cell markers (CD34 3.11%, CD71 53.7%). Chromosomal analysis by G-banding showed 46,XX,t(9;22) (q34;q11) in 23 cells among the 25 metaphase cells analyzed (Fig. 1B). The FISH signals from Vysis indicated abnormal
The patient had leptomeningeal seeding metastasis at diagnosis by cerebrospinal fluid (CSF) analysis. Meanwhile, the patient received leukocyte reduction by leukapheresis from the day of admission. Treatment was started on admission day 8 with induction chemotherapy of hyperCVAD [cyclophosphamide 300 mg/m2 days 1–3; vincristine 1.4 mg/m2 (max. 2 mg) days 4,11; adriamycin 50 mg/m2 day 4; dexamethasone 40 mg days 1–4, 11–14] in combination with Imatinib 600 mg. On induction chemotherapy day 3, the patient showed profuse epistaxis, due to hypofibrinogenemia (platelet 90×109/L, fibrinogen 17 mg/dL). All-trans retinoic acid (ATRA) 45 mg/m2 was added on induction day 7 to the treatment until confirmation of negative
To date, cytogenetic abnormality of t(15;17) has been noted in two BAL cases. One BAL case had FAB ALL-L2 morphology with immunophenotypic pattern showing MPO 53%, CD10 83%, and CD19 87%, a cytogenetic result of t(15;17), +8, and a
Coexistence of
Among the MPAL patients, t(9;22)/
To the best of our knowledge, this is the first case of MPAL with t(9;22) with cryptic expression of
Bone marrow aspiration smear shows lymphoblasts with scanty cytoplasms, lacking Auer rods and granules (Wright-Giemsa stain, ×1,000)
Abbreviations: M, nucleic acid marked ladder; IC, internal control.
Table 1 . Summary of published cases of co-expressing BCR-ABL1 and
Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; ATRA, all trans-retinoid acid; Ara-C, cytosine arabinoside; BCR-ABL1, breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1; CR, complete remission; Dauno, daunorubicin; F, female; FAB, French-American-British; Hb, haemoglobin; Ida, idarubicin; M, male; PCR, polymerase chain reaction; PLT, platelet; PML-RARα, promyelocytic leukemia-retinoid acid receptor; WBC, white blood cell..
Bone marrow aspiration smear shows lymphoblasts with scanty cytoplasms, lacking Auer rods and granules (Wright-Giemsa stain, ×1,000)
Abbreviations: M, nucleic acid marked ladder; IC, internal control.