Kaplan S S, Krause J R, Srodes C H
Am J Clin Pathol. 1984 Aug;82(2):232-5. doi: 10.1093/ajcp/82.2.232.
A patient is described who, during a three-year illness, exhibited multiple phenotypic expressions of leukemia. She was diagnosed initially as having acute lymphoblastic leukemia (ALL) followed by chronic myelogenous leukemia (CML) one and a half years later. Subsequent blast transformations were lymphoblastic, but preterminally, a myeloblastic transformation occurred. These later leukemias probably were not chemotherapy induced, because a review of her initial work-up revealed the presence of a smaller G group chromosome in 1 of 20 metaphases examined. Her clinical course also differs from the CML that presents in lymphoid blast crisis because the Philadelphia chromosome only was emerging at that point. This case illustrates the interrelationships of the various leukemias and supports the hypothesis that a totipotent stem cell may undergo leukemic transformation resulting in variable and simultaneous expressions.
本文描述了一名患者，在三年病程中表现出白血病的多种表型。她最初被诊断为急性淋巴细胞白血病（ALL），一年半后发展为慢性粒细胞白血病（CML）。随后的原始细胞转化为淋巴细胞性，但临终前发生了粒细胞性转化。这些后期白血病可能并非化疗所致，因为回顾其初始检查发现，在检查的20个中期相中，有1个存在较小的G组染色体。她的临床病程也不同于出现淋巴细胞原始细胞危象的CML，因为此时费城染色体才刚刚出现。该病例说明了各种白血病之间的相互关系，并支持了全能干细胞可能发生白血病转化从而导致多种同时出现的可变表达这一假说。
