title: CD4+ acute undifferentiated leukaemia, probably early monoblastic type, developing in a patient with myelodysplastic syndrome and bone marrow fibrosis.
abstract: 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.
authors.affiliation: National Center of Clinical & Transfusional Haematology, Sofia, Bulgaria.
authors.forename: M
authors.initials: M
authors.lastname: Guenova
authors.forename: H
authors.initials: H
authors.lastname: Taskov
authors.forename: J
authors.initials: J
authors.lastname: Zechev
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; D018955:CD36 Antigens; D015704:CD4 Antigens; D006684:HLA-DR Antigens