Institution: University of Michigan
Additional authors:Lauren Smith, MD
Session: B Lymphoblastic Leukemia/Lymphoma
HISTORY
59-year-old female with history of high-grade serous carcinoma of the ovary
(diagnosed three years before); treated with surgery and cytotoxic chemotherapy. Patient presented with bruising. CBC showed pancytopenia and circulating blasts concerning for acute leukemia.DETAILS
0.9 cm right posterior iliac crest bone marrow aspirate and core biopsy.
A 500-cell differential count of the bone marrow touch preparation revealed 94% blasts; characterized by increased nuclear:cytoplasmic ratio, fine chromatin, prominent nucleoli, and scant blue/agranular cytoplasm. Background hematopoiesis was nearly absent.IMMUNOHISTOCHEMISTRY AND FLOW CYTOMETRY
Flow cytometry showed approximately 87% progenitors with immunophenotype consistent with B-lymphoblasts expressing CD19, CD22 (dim) CD34, CD38, CD45 (dim), and TdT. CD10 was negative.
CYTOGENETIC FINDINGS
Cytogenetic studies showed 42~45,XX,add(1p),add(1q),add(2q),add(3q),del(5q),-7,add(10q),
del(11q),add(13p),add(15q),add(16q),-17,-18,-18,-20,+2~5mar,inc[cp10].FISH studies revealed no rearrangement of MLL(11q23) but amplification was present.INTERESTING FEATURES
New data support the existence of therapy-related precursor B-acute lymphoblastic
leukemia. In a study by Tang, et al. the authors suggest that cases with abnormalities including hypodiploidy with loss of chromosomes 5, 7, and 17, as reported in this case, are likely to be therapy-related and have a poor prognosis.PROPOSED DIAGNOSIS
B lymphoblastic leukemia (B-ALL)
CONSENSUS DIAGNOSIS
Therapy-related myeloid neoplasm, mixed phenotype acute leukemia (myeloid/B)