| Session: Extramedullary manifestation of neoplastic myeloid disorder |
| Case number: 136 |
Submitter(s): Lekidelu Taddesse-Heath.
Clinical history
The patient is a 28 year old male with no significant past medical hsitory, presenting with leukocytosis, splenomegaly and lymphadenopathy. CBC showed WBC of 371K, HB 10.3 g/dl, platelet 141K with a differential of 40% neutrophils, 10% bands, 20% metamyelocytes, 12% myelocytes, 5% promyelocytes, 7%myeloblasts, 4% basophils, 1% lymphocyte and 1% monocytes.
Details of gross/microscopic pathology:
Aspirate smear showed marked left shifted (predominantly myelocytes and metamyelocytes) but maturing myeloid hyperplasia with <5% blasts. The core biopsy was 100% cellular with marked myeloid hyperplasia and marked increase in reticulin fibrosis
Formalin fixed Cerival lymph node biopsy showed complete effacement with infiltration by cells of myeloid series and megakaryocytes and sheets of blasts.
Immunophenotype (flow cytometry/immunohistochemistry):
Flow cytometry analysis of bone marrow showed 94% of CD45+ cells showing a continous spectrum of myeloid differentiation with 1% myeloblasts
Flow cytometry analysis of lymph node showed 36% meyloblasts positive for CD34, CD13, HLA-DR, CD33 and MPO.
Cytogenetics:
46,XY,t(9;22)(q34;q11.2) was observed in all metaphases in the bone marrow and lymph node.
Molecular analysis:
Not done.
Interesting feature(s) of submitted case:
Extramedullary manifestation of balst crisis (Myeloid sarcoma) in a patient with Chronic phase of Chronic Myeloid Leukemia in the bone marrow at initial presentation.
Proposed diagnosis:
Myeloid sarcoma with Chronic Myeloid Leukemia in the bone marrow, Chronic phase.
Panel diagnosis:
agree with proposed diagnosis
Comments:
Stains performed by the panel: MPO+, CD68PGM1-, CD34+, NPM- (+in nuclei)
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