Featured Cases

Diagnosis

A bone marrow aspirate from a 36 year old male with a clinical history of bone marrow destruction was submitted to rule out acute myeloid leukemia.   The flow cytometric analysis showed an aberrant myeloblast population present at 87% with characteristics similar to promyelocytic leukemia but with some unusual phenotypic differences.  The specimen was received on at 12:10 on 2/24/04 with results sent to the oncologist by 4:00 the same day.  The specimen was forwarded to Diagnostic Cytogenetics for assessment of chromosomal abnormalities.

sample report

Cytogenetics

Cytogenetic abnormalities were detected the following day showing t(11;17) and monosomy 7 in the abnormal cells. This is a variant of the promyelocytic leukemia, [not the expected t(15;17)] and also included a loss of chromosome 7 often associated with myelodysplasia.

Post Retinoic Acid Treatment

Initial therapy included all-trans-retinoic acid however the aberrant blast cells were still identified in the bone marrow aspirate at 27%.

sample report

Post Chemotherapy

Additional chemotherapy was used to induce the patient into morphologic remission.  However, while flow cytometric analysis showed the loss of the abnormal blast population, all the maturing neutrophils were phenotypically abnormal in a pattern observed in myelodysplasia.  The specimen was forwarded to Diagnostic Cytogenetics for fluorescence in situ hybridization using a probe for chromosome 7.  The results we obtained the next day showing monosomy 7 in 66% of the interphase cells, consistent with the flow cytometric results.

After further chemotherapy the bone marrow aspirate was shown to be in remission by morphology, flow cytometry and cytogenetics.  The patient has proceeded to stem cell transplantation.

sample report

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