Ann Lab Med.  2017 May;37(3):282-284. 10.3343/alm.2017.37.3.282.

The First Case of Therapy-Related Myelomastocytic Leukemia Based on the WHO 2008 Classification and the Recently Proposed Diagnostic Criteria

• Choi WK
• Cho YU
• You E
• Jang S
• Seo EJ
• Park CJ

• KMID: 2369756
• DOI: http://doi.org/10.3343/alm.2017.37.3.282

Abstract

No abstract available.

MeSH Terms

Classification*
Leukemia*

Figure

• 

  Fig. 1 Morphology and phenotype of neoplastic cells. (A) Blood smears revealed non-mast cell blasts (red arrow), a dysplastic neutrophil with the pelgeroid change (yellow arrow), an atypical mast cell exhibiting bi-lobed nuclei (blue arrow), and heavily granulated blast cells suggesting metachromatic blasts (light green arrow; Wright-Giemsa stain, ×1,000). (B) Bone marrow aspirate smears revealed a blast that was medium-sized with round nuclei, finely dispersed chromatin, some distinct nucleoli, and a small amount of basophilic cytoplasm without granules (red arrow). Bone marrow aspirate smears also demonstrated mast cells, including granulated blasts (light green arrow) and atypical mast cells with bi-lobed nuclei (blue arrow). Dysplastic features such as decreased granules were seen in the granulocytic lineage (yellow arrow; Wright-Giemsa stain, ×1,000). (C) The population of neoplastic cells in the blast gate separated into two subgroups, i.e., myeloblasts with CD34+/CD117+ (red circle) and immature atypical mast cells with CD34−/CD117+ (purple circle). (D) Histologic examination of a bone marrow trephine specimen showed a diffuse interstitial increase in mast cells instead of formation of dense clusters (left half; immunohistochemistry for tryptase, ×200). There is no evidence of CD25 positivity (right half; immunohistochemistry for CD25, ×200).Abbreviations: PerCP, peridinin-chlorophyll proteins; PE, phycoerythrin.

Reference

1. Horny HP, Metcalfe DD, Bennett JM, Bain BJ, Akin C, Escribano L, et al. Mastocytosis. In : Swerdlow SH, Campo E, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: International Agency for Research on Cancer (IARC);2008. p. 54–63.

2. Valent P, Sperr WR, Samorapoompichit P, Geissler K, Lechner K, Horny HP, et al. Myelomastocytic overlap syndromes: biology, criteria, and relationship to mastocytosis. Leuk Res. 2001; 25:595–602. PMID: 11377685.

3. Sperr WR, Drach J, Hauswirth AW, Ackermann J, Mitterbauer M, Mitterbauer G, et al. Myelomastocytic leukemia: evidence for the origin of mast cells from the leukemic clone and eradication by allogeneic stem cell transplantation. Clin Cancer Res. 2005; 11:6787–6792. PMID: 16203765.

4. Arredondo AR, Gotlib J, Shier L, Medeiros B, Wong K, Cherry A, et al. Myelomastocytic leukemia versus mast cell leukemia versus systemic mastocytosis associated with acute myeloid leukemia: a diagnostic challenge. Am J Hematol. 2010; 85:600–606. PMID: 20658589.

5. Intzes S, Wiersma S, Meyerson HJ. Myelomastocytic leukemia with t(8;21) in a 3-year-old child. J Pediatr Hematol Oncol. 2011; 33:e372–e375. PMID: 22042288.

6. Johnson RC, Savage NM, Chiang T, Gotlib JR, Cherry AM, Arber DA, et al. Hidden mastocytosis in acute myeloid leukemia with t(8;21)(q22;q22). Am J Clin Pathol. 2013; 140:525–535. PMID: 24045550.

7. Rich A, Sun J, Aldayel AS, Yin CC, Medeiros LJ, Konoplev S. Myelomastocytic leukemia with aberrant CD25 expression: case report and review of the literature. Clin Lymphoma Myeloma Leuk. 2014; 14:e173–e177. PMID: 25022599.

8. Valent P, Sotlar K, Sperr WR, Escribano L, Yavuz S, Reiter A, et al. Refined diagnostic criteria and classification of mast cell leukemia (MCL) and myelomastocytic leukemia (MML): a consensus proposal. Ann Oncol. 2014; 25:1691–1700. PMID: 24675021.

9. Horny HP, Sotlar K, Reiter A, Valent P. Myelomastocytic leukemia: histopathological features, diagnostic criteria and differential diagnosis. Expert Rev Hematol. 2014; 7:431–437. PMID: 25025369.

10. Vardiman JW, Arber DA, Brunning RD, Larson RA, Matutes E, Baumann I, et al. Therapy-related myeloid neoplasms. In : Swerdlow SH, Campo E, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: International Agency for Research on Cancer (IARC);2008. p. 127–129.