Blood Res 2020; 55(3): 130-130  https://doi.org/10.5045/br.2020.2020095
Acute myeloid leukemia with myelodysplasia-related changes and basophilic differentiation
Jean-Baptiste Rieu1, Laetitia Largeaud1, Francois Vergez1, Solene Evrard2
1Haematology Laboratory, 2Clinical Pathology Laboratory, Cancer University Institute of Toulouse, Oncopole, France
Correspondence to: Jean-Baptiste Rieu, Ph.D., Haematology Laboratory, Cancer University Institute of Toulouse, Oncopole, 1 Avenue Irène Joliot-Curie, 31100 Toulouse, France, E-mail: rieu.jeanbaptiste@iuct-oncopole.fr
Received: April 25, 2020; Revised: July 2, 2020; Accepted: July 24, 2020; Published online: August 14, 2020.
© 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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An 84-year-old woman presented with unexplained fatigue and dyspnea. Her WHO performance status was 3 with numerous comorbidities (non-insulin-dependent-diabetes, chronic obstructive pulmonary disease, glaucoma), but no hematological history. She had neither lymphadenopathy, nor splenomegaly, nor hepatomegaly. She presented anemia (Hb, 85 g/L), severe thrombocytopenia (38×109/L), and slight leukocytosis (11×109/L) with 20% blast cells. Bone marrow examination revealed 53% blasts of medium/large size, high nuclear-cytoplasmic ratio, round or oval nucleus with sometimes irregular shape, and basophilic cytoplasm with coarse basophilic granules (A, B, C, black arrow, May-Grünwald-Giemsa, ×1,000). Alcian blue (D, ×400) and toluidine blue staining were both positive. Dysplasia affected all myeloid lineages, but less than 50% of the cells [A, B, C, dysgranulopoiesis: green arrows (decreased granules)], dyserythropoiesis: red arrow (multinuclearity, May-Grünwald-Giemsa, ×1,000). These features indicated acute basophilic leukemia, but the cytogenetic analysis showed a complex, monosomal karyotype (loss of chromosomes 5, 7, 12, 13, 17, and trisomy 8), leading to the diagnosis of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC). Considering age, performance status of the patient, and poor prognosis, palliative care was provided. According to the WHO classification of hematopoietic and lymphoid tissue tumors, cytogenetic abnormalities override AML morphological categories. However, AML-MRC can be associated with basophilic differentiation.



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