| Session: Therapy-related myeloid neoplasm |
| Case number: 183 |
Submitter(s): Marsha C. Kinney.
Clinical history
62 year-old male with a history of squamous cell carcinoma of the tonsil treated with chemotherapy and irradiation. Eighteen months later the patient had the following peripheral counts: WBC = 3,700/ul (70% P, 22% L, 7% Mo, 1% Eo), HCT = 19%, MCV = 84.6 fl, MCH = 28.7 pg, MCHC = 33.9 g/dl, RDW = 16.5%, PLT = 37,000/ul.
Details of gross/microscopic pathology:
Peripheral blood film: mild anisopoikilocytosis, slight left shift; rare nRBC; no blasts
Bone Marrow Morphology: marked erythroid hyperplasia with numerous vacuolated pronormoblasts and basophilic normoblasts. Dyserytrhopoiesis with nuclear fragmentation, lobulation, megaloblastic change, multinucleation, and ringed sideroblasts. Myeloid dysplasia with prominent primary granulation and mild hyposegmentation; monolobate megakaryoctyes. Pronormoblasts form clusters on tissue sections.
Cytochemical studies: erythroid precursors show PAS positivity, which is globular or granular in pronormoblasts and basophilic normoblasts and diffuse in later stage normoblasts; < 3% myeloperoxidase positive blasts.
Immunophenotype (flow cytometry/immunohistochemistry):
Immunophenotype: Flow cytometry: blasts, early erythroid cells were glycophorin A+ and CD13-, CD33-, MPO-, HLA-DR-, CD34-, CD56-, CD15-, CD4-, CD10- and negative for lymphoid antigens CD2, CD7, and CD19.
Paraffin immunoperoxidase: early erythroids are CD43+, hemoglobin A +, EMA+/-, CD75+ (later stage), and MPO-, CD15-, and CD68-.
Cytogenetics:
Karyotype: 46-49, XY, del (5) (q13q33), der(14), der(16), der(17), der(19), -20, der(21), +1-4mar[cp15]/46,XY[5]
Abnormal karyotype in 15/20 cells.
Molecular analysis:
Interesting feature(s) of submitted case:
Rare form of erythroleukemia, likely therapy related; differential diagnosis with myelodysplasia.
Proposed diagnosis:
Diagnosis: Acute erythroid leukemia, subtype pure erythroid leukemia, M6b.
Panel diagnosis:
agree with proposed diagnosis
Comments:
PowerPoint:
Presentation Link
Images:
 |
Figure 1 |
 |
Figure 2 |
 |
Figure 3 |
 |
Figure 4 |
 |
Figure 5 |
 |
Figure 6 |
 |
Figure 7 |
 |
Figure 8 |
 |
Figure 9 |
 |
Figure 10 |
Back to Top
Back to Cases by Session
Back to Cases by Contact Submitter