PMID- 12574966
OWN - NLM
STAT- MEDLINE
DCOM- 20030508
LR  - 20071115
IS  - 0939-5555 (Print)
IS  - 0939-5555 (Linking)
VI  - 82
IP  - 1
DP  - 2003 Jan
TI  - Extramedullary blast crisis of chronic myeloid leukemia after allogeneic 
      hematopoietic stem cell transplantation mimicking aggressive, translocation 
      t(14;18)-positive B-cell lymphoma.
PG  - 47-52
AB  - We report the case of a 42-year-old male patient who was diagnosed with a large 
      tumor of the right thoracic aperture 30 months after unrelated hematopoietic stem 
      cell transplantation (HSCT) for accelerated phase of Philadelphia chromosome 
      (Ph)-positive chronic myeloid leukemia (CML). Biopsy revealed an immature 
      lymphoid neoplasia with blastic tumor cell morphology and immunoreactivity for 
      CD34, CD79a, CD43, and CD30 as well as slight positivity for TdT and CD20. 
      Bcr-Abl rearrangement was found in interphase tumor cell nuclei by fluorescence 
      in situ hybridization (FISH). Furthermore, a translocation t(14;18)(q32;q21) was 
      amplified by polymerase chain reaction (PCR). Bone marrow (BM) examination showed 
      regular hematopoiesis including a negative FISH analysis for Bcr-Abl and complete 
      donor chimerism. Nested PCR from peripheral blood (PB), but not conventional PCR, 
      was positive for the b3a2 Bcr-Abl transcript. Neither radiation nor intensive 
      chemotherapy was capable of achieving a tumor remission, and the patient died 
      from progressive disease 6 months later. Postmortem examinations showed a shift 
      of immunophenotype with appearance of myeloperoxidase-positive tumor cells and 
      loss of lymphoid antigens. In addition, there were characteristic cytogenetic 
      findings of multiple Ph chromosomes and a clonal loss of P53 tumor suppressor 
      gene. The latter was already deleted before HSCT. We conclude that lymphoid 
      neoplasia occurring in our patient should be interpreted as an extramedullary, 
      very immature blast crisis of CML expressing lymphoid differentiation markers 
      rather than a true de novo NHL.
FAU - Kroschinsky, F
AU  - Kroschinsky F
AD  - Universitatsklinikum Carl Gustav Carus, Medizinische Klinik und Poliklinik I, 
      Fetscherstrasse 74, 01307 Dresden, Germany. kroschinsky@mk1.med.tu-dresden.de
FAU - Friedrich, K
AU  - Friedrich K
FAU - Hanel, M
AU  - Hanel M
FAU - Mohr, B
AU  - Mohr B
FAU - Langer, T
AU  - Langer T
FAU - Meinhardt, M
AU  - Meinhardt M
FAU - Thiede, C
AU  - Thiede C
FAU - Bornhauser, M
AU  - Bornhauser M
FAU - Baretton, G
AU  - Baretton G
FAU - Ehninger, G
AU  - Ehninger G
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20021129
PL  - Germany
TA  - Ann Hematol
JT  - Annals of hematology
JID - 9107334
SB  - IM
MH  - Adult
MH  - Blast Crisis/*diagnosis/genetics/immunology
MH  - *Chromosomes, Human, Pair 14
MH  - *Chromosomes, Human, Pair 18
MH  - Cytogenetic Analysis
MH  - Diagnosis, Differential
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Humans
MH  - Immunophenotyping
MH  - Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis/*pathology/therapy
MH  - Lymphoma, B-Cell/*diagnosis/*genetics
MH  - Male
MH  - Sarcoma, Myeloid/diagnosis/pathology
MH  - Thoracic Neoplasms/*diagnosis/*genetics
MH  - *Translocation, Genetic
MH  - Transplantation, Homologous
EDAT- 2003/02/08 04:00
MHDA- 2003/05/09 05:00
CRDT- 2003/02/08 04:00
PHST- 2002/02/21 00:00 [received]
PHST- 2002/10/08 00:00 [accepted]
PHST- 2003/02/08 04:00 [pubmed]
PHST- 2003/05/09 05:00 [medline]
PHST- 2003/02/08 04:00 [entrez]
AID - 10.1007/s00277-002-0569-x [doi]
PST - ppublish
SO  - Ann Hematol. 2003 Jan;82(1):47-52. doi: 10.1007/s00277-002-0569-x. Epub 2002 Nov 
      29.