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Jeong, An, Lim, Woo, Kim, Kim, Lee, and Han: A Case of Bone Marrow Necrosis in B-Acute Lymphoblastic Leukemia with Philadelphia Chromosome at Presentation
Original Article

Lab Med Online 2018;8(4):171-176.

Published online: 19 October 2018

DOI: https://doi.org/10.3343/lmo.2018.8.4.171

A Case of Bone Marrow Necrosis in B-Acute Lymphoblastic Leukemia with Philadelphia Chromosome at Presentation

In Hwa Jeong, M.D.1, Gyu Dae An, M.D.1, Hyeon Ho Lim, M.D.1, Kwang Sook Woo, M.D.1, Kyeong Hee Kim, M.D.1, Jeong Man Kim, M.D.1, Ji Hyun Lee, M.D.2, Jin Yeong Han, M.D.1

1Department of Laboratory Medicine, Division of Hematology-Oncology, Korea

2Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

Corresponding author: Jin Yeong Han Department of Laboratory Medicine, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-5323, Fax: +82-51-255-9366, E-mail: jyhan@dau.ac.kr

Received 8 December 2017       Revised 27 March 2018       Accepted 4 April 2018

Copyright © 2018 The Korean Society for Laboratory Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bone marrow necrosis (BMN) is a pathologic state which is derived from various disease entities. Most commonly, it is accompanied by hematologic malignancies such as acute leukemia. The patients with marrow necrosis are generally known to have dismal prognoses but variations exist according to early diagnosis. Here we report a case of BMN in an acute lymphoblastic leukemia patient with Philadelphia chromosome at presentation.

Keywords: Bone marrow necrosis, B-ALL, Philadelphia chromosome

REFERENCES

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Fig. 1.
Peripheral blood smear showing atypical lymphocytes and a few blast cells (Wright-Giemsa stain, ×200, ×1,000) (A, B). Bone marrow aspirate smear showing hypercellular marrow and coagulative necrosis (Wright-Giemsa stain, ×200) and magnified view of mostly ghost cells and one hematopoietic granulocyte (Wright-Giemsa stain, ×1,000) (C, D). Bone marrow biopsy showing almost no normal hematopoietic elements and only a few fat cells (Hematoxin and eosin stain, ×200) and magnified view of mostly amorphous, eosinophilic substance on bone marrow biopsy (Hematoxylin and eosin stain, ×1,000) (E, F).
lmo-8-171f1.tif
Fig. 2.
Conventional karyotyping shows a 46,XY,t(9;22)(q34.1;q11.2)[13]/46,XY[7] (Giemsa-Leishman-Trypsin banding).
lmo-8-171f2.tif
Fig. 3.
(A) Reverse transcription polymerase chain reaction (RT-PCR) results showing band on eighth lane. (B) Split-out image showing bright band on 8F lane, corresponding to BCL-ABL1 e1a2 fusion transcript (320 base pairs). (C) Follow-up RT-PCR showing no band on third lane. Abbreviations: M, nucleic acid marker ladder; Pc, positive control; Nc, negative control; Pt, patient.
lmo-8-171f3.tif
Fig. 4.
Fluorescent in situ Hybridization study showing dual-color and dual-fusion translocation probes for ABL1 (red) and BCR (green). The circled cell shows one red signal, one green signal, and two yellow signals, respectively.
lmo-8-171f4.tif
Table 1.
Literature of Philadelphia chromosome positive acute lymphoblastic leukemia presented with bone marrow necrosis
Case No. Year N Sex/Age Karyotype References
1 1994 1 M/73 47,XY,+X,der(9)del(9)(p21)t(9;22)(q34;q11),der(22)t(9;22)(q34;q11)[6]/47,idem,del(13)(q22) [4]
        [2]/46,XY[2]  
2 2005 1 M/73 46,XY, t(9;22)(q34;q11) [7]
3 2006 1 F/42 46,XX[20] [6]
4 2009 1 F/23 46,XX,t(9;22)(q34;q11) [5]
5 2015 2   Unspecified [3]
6 2017 1 M/58 46,XY,t(9;22)(q34.1;q11.2)[13]/46,XY[7] Current case
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