Abstract
The presence of two different abnormal cell lines at diagnosis in hematologic malignancies is rare and raises the question of etiology and pathogenesis--two separate malignant lineages occurring together or a common stem cell malignancy? We present a 64-year-old woman who was evaluated for low platelet count and peripheral blasts. On the basis of the morphology, flow cytometry, and lack of myeloid-associated markers, a diagnosis of precursor B-cell acute lymphoblastic leukemia (B-ALL) was made. Cytogenetic analysis of the diagnostic bone marrow (BM) specimen revealed two unrelated abnormal clones--one had a dicentric (7;9)(p11;p11), resulting in the deletion of 7p and 9p, and the other had only trisomy 8. The dic(7;9) is a rare but recurrent abnormality in B-ALL, while trisomy 8 as a sole abnormality is most commonly associated with myeloid malignancies. After standard treatment for B-ALL, BM cytogenetic analysis showed disappearance of the dic(7;9) cell line but persistence of cells with trisomy 8. The presence of two unrelated clones suggestive of concomitant malignancies, possibly B-ALL with an underlying MDS, may have arisen by different mechanisms.
References
Jan 1, 1991·Genes, Chromosomes & Cancer·B JohanssonF Mitelman
Jan 1, 1993·Annals of Hematology·P KapaunA R Zander
Feb 1, 1996·Annals of Hematology·H J WehD K Hossfeld
Jul 1, 1997·Leukemia Research·L S SylvesterJ S Moore
Aug 25, 1999·Cancer Genetics and Cytogenetics·P SharmaA Smith
Dec 18, 2001·Genes, Chromosomes & Cancer·Emanuela MaseratiFrancesco Pasquali
Jul 28, 2005·Leukemia Research·Patricia DisperatiRichard A Wells
Apr 18, 2006·Cancer Genetics and Cytogenetics·Arabella SmithLynda J Campbell
Dec 12, 2007·Clinical & Experimental Metastasis·J Guy LyonsMary R Myerscough
Dec 25, 2007·Blood·Vinod PullarkatFrederick R Appelbaum
Feb 14, 2008·Hematological Oncology·Abir GmidèneAli Saad
Apr 23, 2008·Pathology·D M Ross, T P Hughes
Nov 11, 2008·Cancer Genetics and Cytogenetics·Tae Sung ParkJong Rak Choi
Nov 18, 2008·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Francesco d'AmoreBhavana J Dave
Dec 17, 2008·Cancer·Nobuko HijiyaMelissa M Hudson
Dec 17, 2008·Hematology·Bob Löwenberg