Fukuta Takanori, Nakamoto Shu, Hashimoto Yoshinori, Tanaka Takayuki, Tokuyasu Yusuke, Maruyama Junko, Omura Hiromi, Hino Norihiko, Kuwamoto Satoshi, Murakami Ichiro
Department of Pathology, Tottori Prefectural Central Hospital.
Rinsho Ketsueki. 2017;58(1):26-31. doi: 10.11406/rinketsu.58.26.
A 75-year-old woman was referred to our hospital with suspected leukemia. Complete blood count demonstrated WBC 3,810/µl with 26% blasts, Hb of 11.7 g/dl and Plt of 18.0×10/µl. Bone marrow aspiration revealed blasts (86.3%) with expressions of CD34, CD7, TdT, CD33, and CD117. MPO was negative. Chromosomal analysis of the bone marrow showed isolated trisomy 10 in all leukemic cells (20/20). Swelling of superficial lymph nodes was also observed. Cervical lymph node biopsy revealed leukemic blasts which had the same phenotype as those in the bone marrow except that proliferation of Langerhans cell-like cells (LCs) was observed in the paracortex. LCs had pale cytoplasm and grooved nuclei, and were positive for both CD1a and S100 protein. Trisomy 10 was detected in both the leukemic blasts and the LCs by fluorescence in situ hybridization. This rare case strongly suggests leukemic cells to differentiate into LCs.
一名75岁女性因疑似白血病被转诊至我院。全血细胞计数显示白细胞计数为3810/µl，原始细胞占26%，血红蛋白为11.7 g/dl，血小板计数为18.0×10/µl。骨髓穿刺显示原始细胞（86.3%），表达CD34、CD7、末端脱氧核苷酸转移酶（TdT）、CD33和CD117。髓过氧化物酶（MPO）为阴性。骨髓染色体分析显示所有白血病细胞（20/20）均存在孤立的10号染色体三体。还观察到浅表淋巴结肿大。颈部淋巴结活检显示白血病原始细胞，其表型与骨髓中的相同，但在副皮质区观察到朗格汉斯细胞样细胞（LCs）增殖。LCs细胞质淡染，核有切迹，CD1a和S100蛋白均呈阳性。通过荧光原位杂交在白血病原始细胞和LCs中均检测到10号染色体三体。这一罕见病例强烈提示白血病细胞可分化为LCs。
