Atypical blasts and bone marrow necrosis associated with near-triploid relapse of acute promyelocytic leukemia after arsenic trioxide treatment.
The pathologic features of acute promyelocytic leukemia (APL) with t(15;17)(q22;q21) are highly characteristic, which with few exceptions enable a firm diagnosis to be made on morphologic grounds. An APL patient in first relapse presented with large, bizarre circulating blasts and bone marrow necrosis 2 weeks after chemotherapy consolidation for an arsenic trioxide-induced remission. Although a morphologic diagnosis could not be reached, cytogenetic investigations showed a near-triploid clone with t(15;17), confirming APL in second relapse. This case showed that clonal evolution with additional karyotypic aberrations might alter the blast morphology and pathologic features in APL.
Chim
C S
CS
Department of Medicine and Pathology, Queen Mary Hospital and Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
Lam
C C K
CC
Wong
K F
KF
Man
C
C
Kam
S
S
Kwong
Y L
YL
D000328:Adult; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use*; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D002869:Chromosome Aberrations; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007621:Karyotyping; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000473:pathology*; D009336:Necrosis; D010087:Oxides / Q000627:therapeutic use*; D011003:Ploidies; D012008:Recurrence
D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide