title: Acute lymphoblastic leukemia with eosinophilia lacking peripheral blood leukemic cell: a rare entity.
abstract: We describe a 57-year-old woman who was diagnosed as precursor B-cell acute lymphoblastic leukemia with marked eosinophilia (ALL-eo). She presented with low grade fever and eosinophilia (absolute count 16.5 × 10(9)/l). Most of eosinophils had hypogranular cytoplasm. Immature cells were absent in her peripheral blood. Since her platelet count was low, bone marrow examination was carried out. 57.2 % of nucleated cells were blastic cells positive for CD10, 19, and 20. Chromosomal analysis revealed a karyotype of 46,XX,t(5;14)(q31;q32). Despite induction chemotherapy, her disease progressed and she died of sepsis a month later. ALL-eo is extremely rare and the diagnosis might be delayed unless leukemic cells are seen in peripheral blood. Therefore, bone marrow should be examined as soon as possible in cases with eosinophilia not only for the differential diagnosis of eosinophilic disorders but also not to overlook ALL-eo.
authors.affiliation: Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981 Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana-Shichono-cho, Yamashina-ku, Kyoto, 607-8086 Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Shimura
authors.affiliation: Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana-Shichono-cho, Yamashina-ku, Kyoto, 607-8086 Japan.
authors.forename: Mihoko
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana-Shichono-cho, Yamashina-ku, Kyoto, 607-8086 Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohkawara
authors.affiliation: Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981 Japan.
authors.forename: Muneo
authors.initials: M
authors.lastname: Ohshiro
authors.affiliation: Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981 Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tsutsumi
authors.affiliation: Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981 Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Department of Hematology/Oncology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horiike
authors.affiliation: Department of Hematology/Oncology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Yokota
authors.affiliation: Department of Hematology/Oncology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taniwaki
keywords: Acute lymphoblastic leukemia; Eosinophil; Precursor B cell; t(5;14)