title: Distinguishing between proliferating nodal lymphoid blasts in chronic myelogenous leukemia and non-Hodgkin lymphoma: report of three cases and detection of a bcr/abl fusion signal by single-cell analysis.
abstract: Lymph node biopsies were analyzed from three patients with chronic myelogenous leukemia (CML) showing nodal blast proliferation. Immunohistochemically, the blasts from all three patients had an immature marker profile with a T-blast population (cCD3+, CD4-, CD7+, CD8-, CD99+, terminal deoxynucleotidyl transferase +) and a hematopoietic progenitor cell marker (CD34). In two patients, the blasts also expressed myeloid lineage specificity (naphthol AS-D chloroacetate esterase activity and myeloperoxidase positivity). However, it was difficult to distinguish between blast proliferation in CML and non-Hodgkin lymphoma from these immunohistopathological findings alone. Subsequently, bcr gene rearrangement and bcr/abl mRNA expression were detected by Southern blot and reverse transcription-polymerase chain reaction analysis of the lymph nodes. Fluorescence in situ hybridization (FISH) analysis of lymph node touch smears also disclosed bcr/abl gene fusion signals in the blasts of all patients, confirming that the blasts were derived from Philadelphia chromosome-positive CML. Accurate discrimination between the proliferating nodal blasts of CML and non-Hodgkin lymphoma is essential for determining subsequent therapy. FISH analysis of bcr/abl in single-cell blast preparations is an efficient tool that allows rapid, accurate cytopathological diagnosis of extramedullary blast-phase CML and its discrimination from non-Hodgkin lymphoma.
authors.affiliation: Department of Pathology, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan. ayashima@iwate-med.ac.jp
authors.forename: Akiko
authors.initials: A
authors.lastname: Yashima-Abo
authors.forename: Takashi
authors.initials: T
authors.lastname: Satoh
authors.forename: Toru
authors.initials: T
authors.lastname: Abo
authors.forename: Yusei
authors.initials: Y
authors.lastname: Aoki
authors.forename: Shugo
authors.initials: S
authors.lastname: Kowata
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ito
authors.forename: Yoji
authors.initials: Y
authors.lastname: Ishida
authors.forename: Hitomi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Chihaya
authors.initials: C
authors.lastname: Maesawa
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Masuda
mesh_terms: D000071443:12E7 Antigen; D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D018952:Antigens, CD34 / Q000032:analysis; D019011:Antigens, CD7 / Q000032:analysis; D015139:Blotting, Southern; D017252:CD3 Complex / Q000032:analysis; D015815:Cell Adhesion Molecules / Q000032:analysis; D049109:Cell Proliferation; D004253:DNA Nucleotidylexotransferase / Q000032:analysis; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D008198:Lymph Nodes / Q000737:chemistry / Q000378:metabolism / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009283:Naphthol AS D Esterase / Q000032:analysis; D009195:Peroxidase / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000071443:12E7 Antigen; D015703:Antigens, CD; D018952:Antigens, CD34; D019011:Antigens, CD7; D017252:CD3 Complex; C061828:CD99 protein, human; D015815:Cell Adhesion Molecules; D009195:Peroxidase; D016044:Fusion Proteins, bcr-abl; D004253:DNA Nucleotidylexotransferase; D009283:Naphthol AS D Esterase