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Case 81

Hematopathology Case
 

CLINICAL INFORMATION

 

A 65 years old American African male, HIV+. Previously diagnosed as CMML and myeloid sarcoma (case 79). Bone marrow biopsy.

 

 

PERIPHERAL BLOOD SMEAR AND DIFFERENTIATION

 

    WBC, 4.16 K/uL 

       NEUTR,   1.50 K/uL      

       LYMPH,   1.15 K/uL          

       BLASTS,  1.40 K/uL     

    RBC, 3.91 M/uL 

    HGB, 12.7 g/dL

    PLT, 114  K/uL

 

 

Wright-Giemsa, 100

Wright-Giemsa, 100

 

 

Wright-Giemsa, 100

Wright-Giemsa, 100

 

 

BONE MARROW CORE BIOPSY AND CLOT

 
 

 

HE, 20

HE, 40

 

 

HE, 20

CD34, 20

 

 
 

CD34, 40

 

 

FLOW CYTOMETRY

 

           Total events =     H gate Dim CD45+        A gate Bright CD45+

            47659             events = 9218(44%       events = 2693(13%

                              of total events         of total events

                              analyzed)               analyzed)

       

            CD45+/CD14-            100%                  100%

            Total CD14+             <2%

            Total CD13+             <2%

            CD34+/CD13+             <2%

            Total CD15+             <2%

            CD34+/CD15+             <2%

            Total CD33+             98%

            CD34+/CD33+             96%

            Total CD34+             97%

            Total CD11b+             5%

            Total CD41+              4%

            Total CD71+             96%

            CD34+/CD71+             95%

            Total CD117+             5%

            CD34+/CD117+             5%

            Total HLA DR+           71%

            CD34+/HLA DR+           69%

            Total CD19+             <2%                    10%

            CD19+/CD20+             <2%                    10%

            Total CD38+             82%                    87%

            CD19+/CD38+             <2%                    10%

            CD19+/CD10+             <2%                    <2%

            Total CD7+              81%                    84%

            CD2+/CD7+               <2%                    83%

            CD3+/CD5+               <2%                    64%

            CD3+/CD4+               <2%                     8%

            CD3+/CD8+               <2%                    44%

            CD3-/CD56+              50%                    12%

       

     INTERPRETATION:

            An aberrant population of blasts expressing CD34, CD33, CD71,

       CD38, CD7 and HLA/DR, and CD56 (partial) is identified at

       approximately 42% of the total events analyzed.  The immunophenotype

       is similar to patient's previous blasts and is consistent with acute

       myeloid leukemia. 

       

 

   
 
 
 
 
 
 
 
 
   

CYTOGENETICS

 

Cytogenetic analysis revealed the persistence and progression of an abnormal hypodiploid clone characterized by an unbalanced translocation between 7p and 12q, a balanced translocation between 9p and 19q, monosomy 12 and additional unknown material on 12p. 

 

NOMENCLATURE:

       45,XYder(7)t(7;12)(21;q14),t(9;19)(p13;q13.3),-12add(12) (12p)(p11.2)

       

 

 

Click here for diagnosis and case discussion.

 

Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan