| Session: Myelodysplastic / myeloproliferative disease |
| Case number: 150 |
Submitter(s): Antoine de Mascarel, Marie Parrens, Pierre Fialon, Maite Longy.
Clinical history
70 year old man presented a moderate thrombocytopenia for 2 years. In september 2006, fatigue, fever, weight loss, severe inflammatory syndrome without obvious infectious etiologies. WBCs : Hb 8,9g/dl, WCC 36,6x109/L, neutrophils 57%, lymphocytes 9%, monocytes 26%, myelocytes 6%, blasts 2%, platelets 35x109g/L.
In December 2006, worsening of general state and inflammatory syndrome, with pleural effusion, hepato-splenomegaly. Hepatic cytolysis. BM aspirate: chronic myelomonocytic leukaemia type 2 (blastes: 9%, myeloblastes 1%, myelocytes and metamyelocytes 23%, neutrophils 32%, erythroblastes 4%, lymphocytes 6%, monocytes 19%, promonocytes 6%)
Because of suspicion of tuberculosis and hepatomegaly a liver biopsy was performed.
Details of gross/microscopic pathology:
Hepatic sinusoids infiltrated by small "hematologic" cells.
Immunophenotype (flow cytometry/immunohistochemistry):
Small cells in hepatic sinusoids are negative with cd20, cd3, cd4, cd56, cd34, cd163 and positive with cd68-KP1, cd43, cd15, MPO, lyzozyme and Ki67 (80%).
Cytogenetics:
bone marrow: no cytogenetic clonal abnormality.
Molecular analysis:
No finding of Philadelphia chromosome or BCR/ABL fusion gene.
Interesting feature(s) of submitted case:
Tumoral form of CMML with liver leukaemic infiltration and hyperleucocytosis.
Proposed diagnosis:
Liver localization of chronic myelomonocytic leukaemia.
Panel diagnosis:
agree with proposed diagnosis; CMML-2
Comments:
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