CD4+ acute undifferentiated leukaemia, probably early monoblastic type, developing in a patient with myelodysplastic syndrome and bone marrow fibrosis.
We report here a patient who presented with pancytopenia, hypercellular bone marrow and three-lineage dysplasia associated with an increase of reticulin fibres. After a 5-month period, anaemia and thrombocytopenia progressed very rapidly and the white blood count increased showing 45% blasts with monocytoid morphology, but cytochemically undifferentiated in nature. The immunophenotype revealed an unusual expression of CD4, CD36 and HLA-DR in the absence of any other myeloid or lymphoid lineage-associated markers. The patient died unexpectedly during the course of chemotherapy. The occurrence of CD4, CD36 and HLA-DR on the blast cells cannot determine the lineage of differentiation with certainty but provides some evidence that the leukaemic cells were probably derived from a very early monocytic progenitor with maturation arrest. These cells had apparently complex interactions with pathologic megakaryocytes and cytokine production.
Guenova
M
M
National Center of Clinical & Transfusional Haematology, Sofia, Bulgaria.
Taskov
H
H
Zechev
J
J
D014408:Biomarkers, Tumor / Q000096:biosynthesis; D018955:CD36 Antigens / Q000096:biosynthesis; D015704:CD4 Antigens / Q000096:biosynthesis*; D002454:Cell Differentiation / Q000502:physiology; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000096:biosynthesis; D006801:Humans; D007948:Leukemia, Monocytic, Acute / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications*; D055728:Primary Myelofibrosis / Q000150:complications*; D012680:Sensitivity and Specificity
D014408:Biomarkers, Tumor; D018955:CD36 Antigens; D015704:CD4 Antigens; D006684:HLA-DR Antigens