The coexistence of chronic myeloid leukaemia(CML) and chronic lymphocytic leukemia(CLL) has been reported occasionally in literature, with only seven cases of simultaneous occurrence of these two diseases. We present here a case of 57 yr male patient where a complete blood count and differential done using volume conductivity scatter (VCS) technology suggested a diagnosis of CML with CLL. It was further confirmed by immunophneotyping and cytogenetic analysis. The patient was started on tyrosine kinase inhibitor, 400 mg once daily. Four months after the treatment, patient is doing fine with a count of 22 × 10 9 /L and 64% lymphocytes.
Presence of microfilariae in bone marrow aspirate is an uncommon finding and its association with leukaemia has rarely been described. We present a case of young female from north India in which bancroftian microfilariae was seen in peripheral blood and bone marrow smears as an incidental finding along with 88 % myeloid blast that were positive on myeloperoxidase stain. There was no associated eosinophilia. She was started on diethylcarbazine for microfilariae, before the start of induction chemotherapy for acute myeloid leukaemia. Presently she is post induction and is doing fine.
Mixed phenotypic acute leukemia (MPAL) is a rare disorder with an incidence of less than 2% of all acute leukemia using the recent 2008 WHO criteria. Common subtypes encountered are the B/myeloid and T/myeloid; B/T or trilineage MPAL being an exception. We discuss here a case of 20-year-male patient who presented with pallor and generalised lymphadenopathy. Peripheral blood smear examination showed presence of 61% blasts of lymphoid morphology. Immunophenotyping by multicolor flow cytometry showed two distinct populations of blasts with T and B phenotype respectively. He was diagnosed as MPAL with two distinct blast lineages. Conventional karyotyping done on bone marrow sample showed t(9;22)(q34;q11)(Ph 1). Induction was started using ALL based protocol. The patient is on follow up with post induction marrow being in morphological remission.
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive neoplasm classified under "acute myeloid leukemia (AML) and related precursor neoplasm" by current WHO classification. Elderly male are commonly affected with cutaneous lesion being the hallmark of disease presentation. The disease progresses rapidly and sooner or later involves bone marrow and peripheral blood. Cases presenting primarily as leukemia without cutaneous involvement is a rarity with about 29 cases reported in literature till date. Characteristic immunophenotype of CD4 + /CD56 +/- cells expressing antigens associated with plasmacytoid dendritic cells like CD123, TCL1, BDCA2/CD303, cutaneous lymphocyte-associated and interferon dependent molecule MxA, in absence of any other lineage specific marker confirms the diagnosis. The disease has a poor survival and no standardized therapeutic strategy in the current scenario. A case of 25-year-male presenting with leukemic BPDCN without cutaneous involvement is presented here, who was treated with AML like protocol followed by hematopoietic stem cell transplantation, but succumbed to the disease within 8 months of diagnosis. The present case is being first to be reported from India.
While giant cell tumour of bone is a relatively common tumour in adults, it is exceedingly rare in children. Multicentric metachronous giant cell tumour is an even rarer presentation of this tumour in skeletally immature patients. We present here the challenges in management of this rare tumour. A 12-year-old girl presented with a giant cell tumour affecting four different bones sequentially, three times within a 3-year period. The disease first appeared in the right distal fibula, then a year later in ipsilateral talus and calcaneus and finally a year later, in the T5 vertebral body, all requiring surgical treatment. Our strategy was to manage this lesion aggressively based on the limited literature available and present our own long-term surveillance strategy. Our patient responded well to treatment each time and has remained disease-free for 24 months from her last surgery. This is a rare case of metachronous multicentric giant cell tumour of bone in a skeletally immature patient requiring aggressive treatment and surveillance.
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