ACUTE MONOBLASTIC LEUKEMIA-LEUKEMIA CUTIS
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2002, Vol 19, Issue 3
Abstract
A 72-year-old man was evaluated for mild anemia in our Hematology Outpatient Department. Bone marrow morphology was diagnostic of MDS; the French-American-British (FAB) type was refractory anemia with ringed sideroblasts (RARS). The administration of erythropoietin with and without G-CSF had no effect to anemia. Two years later, hemoglobin level was 7.8 g/dL, white blood cell (WBC) count was 3.2 × 109/L with a normal differential count, and platelet count 115 × 109/L. Bone marrow aspirate and biopsy showed dysplastic erythroid hyperplasia and 4% myeloblasts, a Prussian blue reaction as in Figure 1, and features of multilineage dysplasia. Karyotype was normal. Anemia worsened 3 months later, necessitating monthly red blood cell transfusions. Violaceous nodules, each measuring 0.5 to 1 cm, appeared across the patient's back and abdomen (Figure 2). Biopsy specimens showed dermal infiltration by monoblasts staining immunohistochemically for lysozyme, and myeloperoxidase. Hemoglobin level was 7.2 g/dL, WBC count was 26.8 × 109/L with 35% neutrophils, 32% lymphocytes, 25% monocytes, 2% basophils, and 6% blasts, and platelet count was 93 × 109/L. The bone marrow was hypercellular, (Figure 3). Blasts were positive with -naphthyl butyrate esterase and expressing CD45, HLA-DR, CD2, CD4, CD11b, CD11c, CD13, CD14, CD15, and CD33 by flow cytometry. Karyotype was again normal. The diagnosis was made, and the appropriate therapy was initiated. Skin lesions regressed and disappeared completely by 7 weeks. A bone marrow sample after the termination of therapy showed reversion to MDS, without increased blast count. Anemia worsened again, necessitating transfusions. The patient had a fatal myocardial infarction 4 months later.
Authors and Affiliations
J. Meletis, M. Tsironi, E. Apostolidou
Keywords
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