clone over the very hypodiploid clone. Acknowledgments. Prof. Janet D. Rowley provided encourage- ment and helpful discussion. Dr. John L. Ziegler reviewed ...
Case Reports A Hypodiploid Clone and Its Duplicate in Acute Lymphoblastic Leukemia FIORELLA SHABTAI, M.SC, URI H. LEWINSKI, M.D., LEA HAR-ZAHAV, M.D., UZI GAFTER, M.D. ISAAC HALBRECHT, M.D., AND MEIR DJALDETTI, M.D.
NUMERICAL AND STRUCTURAL chromosomal aberrations are a frequent and often characteristic finding in various types of leukemias. 813 However, hypodiploidy of fewer than 40 chromosomes is a very rare observation.9 Recently, two cases with concomitant 27;54 chromosomes have been reported.3,5 We report a third case of a patient with acute lymphoblastic leukemia in whom two concomitant cell populations with 32;64 chromosomes were found, and describe the characteristic features of the three cases.
B. Gattegno Research Institute of Human Reproduction and Fetal Development, and Department of Medicine "B", Hasharon Hospital, Petah-Tiqva, and Tel Aviv University Medical School, Tel Aviv, Israel
laboratory studies included: hemoglobin 8.2 g/dl, hematocrit 24%, leukocyte count 1,600/mm3 with a differential of 46% segmented cells, 6% band forms, 4% eosinophils, 32% lymphocytes, 2% monocytes, 8% blast cells, and 2% myelocytes. The platelet count was 72,000-100,000/mm\ reticulocytes 1.2%, serum iron 175 g/dl, total iron-binding capacity 480 g/dl, haptoglobin 500 mg/dl, plasma hemoglobin 7.3 mg/dl. Coombs' test was negative. Vitamin B12 was 323 pg/ml, folic acid 70 ng/ml, and peripheral blood leukocytic alkaline phosphatase score was 32. The lysozymes in blood and urine were within the normal limits. Cold agglutinins, serologic tests for collagen diseases, and tests for antismooth muscle and antimitochondrial antibodies were all negative. Urea was 60 mg/dl, creatinine 1.3 mg/dl, serum glutamic oxaloacetic transaminase 96 units, serum glutamic pyruvic transaminase 81 units, uric acid 10 mg/dl, alkaline phosphatase 4 units (Bessey-Lowry), and lactate dehydrogenase to as high as 420 units. Bone marrow aspiration biopsy smears showed infiltration by large cells (Fig. 1) with basophilic cytoplasm containing many small vacuoles. The nucleus was large, with fine chromatin, frequently with one nucleolus. Some of the cells were nearly double the size
Report of a Case A 63-year-old man was hospitalized in January 1977 because of weakness and pancytopenia. Since 1975 he had had arthrosis of the right hip joint, which had been treated with indomethacin. Three months prior to his hospitalization, he had started to complain of weakness and excessive sweating. On physical examination he appeared pale, in fair general condition, with tachycardia (120 beats/min). Blood pressure was 130/80 mm Hg. Small lymph nodes were palpable in his neck and in both axillae. A rumbling systolic murmur was heard over the whole precordium, with maximal intensity at the apex. The liver was palpable 5 cm below the costal margin, soft and not tender, and the spleen was not enlarged. There was ankylosing of the right hip. Results of Received May 30, 1978; received revised manuscript and accepted for publication November 24, 1978. Address reprint requests to Prof. Djaldetti: Department of Medicine "B", Hasharon Hospital, Petah-Tiqva, Israel.
FIG. 1. Lymphoblasts in bone marrow aspiration biopsy. Wright's stain, x 1,200.
0002-9173/79/1200/1018 $00.85 © American Society of Clinical Pathologists 1018
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Shabtai, Fiorella, Lewinski, Uri H., Har-Zahav, Lea, Gafter, Uzi, Halbrecht, Isaac, and Djaldetti, Meir: A hypodiploid clone and its duplicate in acute lymphoblastic leukemia. Am J Clin Pathol 72: 1018-1024, 1979. Examination of the bone marrow of a 63-year-old man who had acute lymphoblastic leukemia revealed a population of cells with 32 chromosomes and another population with 64 chromosomes, the karyotypical exact duplicate of the first clone. The karyotypic evolution was studied and the findings compared with those described in two similar cases previously reported. It is postulated that severe hypodiploidy is associated with reduced capability of cellular survival, promoting a strong tendency for duplication. (Key words: Acute lymphoblastic leukemia; Hypodiploidy; Chromosomes; Bone marrow.)
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CASE REPORTS
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FIG. 2. Electron micrograph of an immature cell, showing a high nuclear-cytoplasmic ratio, scanty heterochromatin, and a round nucleolus, x 13,900.
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of the remaining cells. Cytochemical stainings with a-naphthyl acetate and naphthol ASD chloroacetate were negative; periodic acid-Schiff (PAS) was positive. The leukocytic alkaline phosphatase score in bone marrow smears was 400 (maximal), and staining for iron was 2+ positive.
FIG. 3. An immature cell with a lobulated nucleus. Notice the lipid droplets in the cytoplasm, xl 1,580.
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Liver biopsy showed infiltration of the lobules and periportal spaces by young cells. Cells of the same type were found later in pleural effusions. The diagnosis of lymphoblastic leukemia was tentatively made, and chemotherapy with rubidomycin and Ara-C was started. The
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A.J.C.P. • December 1979
FIG. 4. Nuclear pockets in an immature cell. x21,830.
Electron-microscopic Findings Buffy coat, bone marrow cells, and small pieces of the liver were fixed in cold 1% glutaraldehyde in phosphate buffer, p H 7.4, postfixed in osmium tetroxide, dehydrated in graded alcohols, and embedded in Epon
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