Tanaka Yasuhiro, Tanaka Atsushi, Hashimoto Akiko, Hayashi Kumiko, Shinzato Isaku
Department of Hematology and Clinical Immunology, Nishi-Kobe Medical Center, Hyogo, Japan.
Molecular Genetic Analysis Department, LSI Medience Corporation, Tokyo, Japan.
Case Rep Hematol. 2017;2017:4695491. doi: 10.1155/2017/4695491. Epub 2017 Mar 27.
Myelodysplastic syndrome (MDS) terminally transforms to acute myeloid leukemia (AML) or bone marrow failure syndrome, but acute myeloid leukemia with basophilic differentiation has been rarely reported. An 81-year-old man was referred to our department for further examination of intermittent fever and normocytic anemia during immunosuppressive treatment. Chromosomal analysis showed additional abnormalities involving chromosome 7. He was diagnosed as having MDS. At the time of diagnosis, basophils had not proliferated in the bone marrow. However, his anemia and thrombocytopenia rapidly worsened with the appearance of peripheral basophilia three months later. He was diagnosed as having AML with basophilic differentiation transformed from MDS. At that time, monosomy 7 was detected by chromosomal analysis. We found that basophils can be confirmed on the basis of the positivity for CD203c and CD294 by flow cytometric analysis. We also found by cytogenetic analysis that basophils were derived from myeloblasts. He refused any chemotherapy and became transfusion-dependent. He died nine months after the transformation. We should keep in mind that MDS could transform to AML with basophilic differentiation when peripheral basophilia in addition to myeloblasts develops in patients with MDS.
骨髓增生异常综合征（MDS）最终会转化为急性髓系白血病（AML）或骨髓衰竭综合征，但具有嗜碱性分化的急性髓系白血病鲜有报道。一名81岁男性因在免疫抑制治疗期间出现间歇性发热和正细胞性贫血而转诊至我科。染色体分析显示存在涉及7号染色体的额外异常。他被诊断为患有MDS。诊断时，骨髓中嗜碱性粒细胞尚未增殖。然而，三个月后随着外周血嗜碱性粒细胞增多，他的贫血和血小板减少迅速恶化。他被诊断为从MDS转化而来的具有嗜碱性分化的AML。当时，染色体分析检测到7号染色体单体。我们发现通过流式细胞术分析，基于CD203c和CD294的阳性可确认嗜碱性粒细胞。我们还通过细胞遗传学分析发现嗜碱性粒细胞源自原始粒细胞。他拒绝任何化疗并变得依赖输血。转化九个月后他去世。我们应牢记，当MDS患者除原始粒细胞外还出现外周血嗜碱性粒细胞增多时，MDS可能会转化为具有嗜碱性分化的AML。
