Sun T, Wu E
Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Denver, Colorado 80220, USA.
Am J Hematol. 2001 Mar;66(3):207-12. doi: 10.1002/1096-8652(200103)66:3<207::aid-ajh1046>3.0.co;2-q.
We report a case of acute monoblastic leukemia with t(8;16) in a 71-year-old man who had rapid rise of leukocyte counts from 20.3 x 10(9)/l to 62.7 x 10(9)/l in two weeks. The peripheral blood showed many granular promonocytes that led to the consideration of acute promyelocytic leukemia of the hypogranular variant. The bone marrow, however, revealed mainly monoblasts with erythrophagocytosis. Cytogenetic study finally confirmed the diagnosis of acute monoblastic leukemia with t(8;16). The patient died three days after admission. The demonstration of these two characteristic features of this subtype, granular promonocytes and erythrophagocytosis by monoblasts, separately, in the peripheral blood and bone marrow is unusual and misleading. This cytogenetic abnormality can be demonstrated only in M5 and M4 with characteristic clinical features of disseminated intravascular coagulation, extramedullary involvement, and poor prognosis. Although it is not a common disease, this specific subtype of acute myelogenous leukemia is consistently associated with a specific cytogenetic marker, thus it should be considered a distinct clinicopathologic entity.
我们报告了一例71岁男性的急性单核细胞白血病伴t(8;16)，其白细胞计数在两周内从20.3×10⁹/L迅速升至62.7×10⁹/L。外周血显示许多颗粒状原单核细胞，这导致考虑为低颗粒型急性早幼粒细胞白血病。然而，骨髓主要显示原单核细胞并伴有红细胞吞噬现象。细胞遗传学研究最终确诊为急性单核细胞白血病伴t(8;16)。患者入院三天后死亡。在外周血和骨髓中分别出现这种亚型的两个特征性表现，即颗粒状原单核细胞和原单核细胞的红细胞吞噬现象，是不常见且具有误导性的。这种细胞遗传学异常仅在具有弥散性血管内凝血、髓外受累及预后不良等特征性临床表现的M5和M4中才能被证实。虽然这不是一种常见疾病，但这种特定亚型的急性髓系白血病始终与一种特定的细胞遗传学标志物相关，因此应被视为一种独特的临床病理实体。
