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Case 81

Hematopathology Case

CLINICAL INFORMATION

 

A 65-year-old American African male had a history of HIV infection. He was previously diagnosed as CMML and myeloid sarcoma (Case 79). A bone marrow biopsy was performed.

 

 

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:

A large population of blasts is detected, expressing CD7, CD33, CD34, CD38,dim CD45,CD56 (partial), CD71,and HLA/DR.      

 

   
 
 
 
 
 
 
 
 
   

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