A Case of Promyelocytic Leukemia with Basophil-like Granules

Kyung-Ran Jun; Hyun-Sook Chi; Chan-Jeoung Park; Sung-Su Jang; Kyoo-Hyung Lee

doi:10.5045/kjh.2005.40.2.120

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Jun, Chi, Park, Jang, and Lee: A Case of Promyelocytic Leukemia with Basophil-like Granules

Case Report

Korean J Hematol 2005;40(2):120-123.

Published online: 21 June 2005

DOI: https://doi.org/10.5045/kjh.2005.40.2.120

A Case of Promyelocytic Leukemia with Basophil-like Granules

Kyung-Ran Jun, M.D.¹, Hyun-Sook Chi, M.D.¹, Chan-Jeoung Park, M.D.¹, Sung-Su Jang, M.D.¹, Kyoo-Hyung Lee, M.D.²

¹Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

²Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Correspondence to: Hyun-Sook Chi, M.D. Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center 388-1 Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-4502, Fax: +82-2-478-0884 E-mail: hschi@amc.seoul.kr

Received 25 April 2005 Revised 23 May 2005 Accepted 13 June 2005

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

According to the FAB (French-American-British) classification, two main cytological subtypes are recognized: the classical hypergranular and the microgranular variant. However, other morphological variants have been reported in the literature. Therefore, careful examination is needed to diagnose acute promyelocytic leukemia (APL). Herein, the case of an APL variant, with basophil-like granules, occurring in a 65 year-old woman admitted due to high fever is reported. The peripheral blood showed blasts and increased basophils. A bone marrow smear showed leukemic blasts, with irregular nuclei and coarse basophil-like granules, in the cytoplasm. Cytoplasmic vacuoles were also noted, but no Auer rod was found. The blasts showed positivity toward MPO, tryptase and toluidine blue staining. The immunophenotypes revealed a myeloid lineage, with aberrant expression of CD2 and CD7. The karyotype was t(15;17)(q22;q12) in 17 out of 20 metaphases. The RT-PCR was positive for long form PML/RARα transcripts. Four weeks after chemotherapy, her bone marrow status findings were in complete remission, with the karyotype converted to normal. Basophil-like granules in the blasts and promyelocytes became decreased during the course of all-transretinoic acid (ATRA) treatment. The chimeric transcript of PML/RARα converted to negative after consolidation chemotherapy.

Keywords: Leukemia, Promyelocytic, Acute, Variant, Basophils

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Fig. 1.

Bone marrow aspiration smear reveals increased myeloblasts, basophils, and promyelocytes with basophil-like granules in some cells (Wright stain, × 1,000).

Fig. 2.

C ytochemical stains for myeloperoxidase (A, touch print), tryptase (B, aspirate), and toluidine blue (C, aspirate) show positive reaction in promyelocytes (× 1,000).

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