Korean J Hematol.  2012 Sep;47(3):229-232. 10.5045/kjh.2012.47.3.229.

ZBTB16-RARalpha variant of acute promyelocytic leukemia with tuberculosis: a case report and review of literature

• Palta A
• Dhiman P
• Cruz SD

• KMID: 2251959
• DOI: http://doi.org/10.5045/kjh.2012.47.3.229

Abstract

A 23-year-old male presented with pulmonary tuberculosis and swelling of both lower limbs. He was put on antitubercular treatment. Hemogram showed mild anemia and Pseudo Pelger-huet cells. The bone marrow (BM) examination showed 52% promyelocytes with regular round to oval nuclei, few granules and were positive for CD13 and CD33, and negative for HLA-DR. Cytogenetic analysis of the BM aspirate revealed an apparently balanced t(11;17)(q23;q21). Final diagnosis rendered was acute promyelocytic leukemia (APL) with t(11;17)(q23;q21); ZBTB16/RARA. APL is a distinct subtype of acute myeloid leukemia. The variant APL with t(11;17)(q23;q21) cases that are associated with the ZBTB16/RARA fusion gene have been reported as being resistant to all-trans-retinoic acid (ATRA). Therefore, differential diagnosis of variant APL with t(11;17)(q23;q12) from classical APL with t(15;17)(q22;q12); PML-RARA is very important. Here we have discussed the importance of distinct morphology of variant APL and also significance of rare presentation with tuberculosis.

Keyword

ZBTB16-RARalpha variant; Tuberculosis; Promyelocytes

MeSH Terms

Anemia
Bone Marrow
Cytogenetic Analysis
Diagnosis, Differential
Granulocyte Precursor Cells
HLA-DR Antigens
Humans
Leukemia, Myeloid, Acute
Leukemia, Promyelocytic, Acute
Lower Extremity
Male
Tretinoin
Tuberculosis
Tuberculosis, Pulmonary
Young Adult
HLA-DR Antigens
Tretinoin

Figure

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  Fig. 1 Peripheral blood smear showing occasional promyelocyte (Leishman's stain; magnification, ×1,000).

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  Fig. 2 Bone marrow aspirate showing promyelocytes having round to oval nuclei (May-Grunwald-Giemsa; magnification, ×1,000).

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  Fig. 3 Bone marrow aspirate showing promyelocytes having myeloperoxidase (MPO) positivity (MPO stain; magnification, ×1,000).

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  Fig. 4 Cytogenetic profile showing t(11;17)(q23;q21).

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