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.
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.
Yashima-Abo
Akiko
A
Department of Pathology, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan. ayashima@iwate-med.ac.jp
Satoh
Takashi
T
Abo
Toru
T
Aoki
Yusei
Y
Kowata
Shugo
S
Ito
Shigeki
S
Ishida
Yoji
Y
Fujiwara
Hitomi
H
Maesawa
Chihaya
C
Masuda
Tomoyuki
T
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
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