PMC3255497_01
The peripheral blood smear shows an increased number of medium- to large-sized blastoid cells with polymorphous nuclei and basophilic cytoplasm (Wright-Giemsa stain, x1,000).
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F1
The initial complete blood count results were as follows: hemoglobin level, 10.5 g/dL; platelet count, 176x109/L; and white blood cell count, 125.8x109/L, comprising 5% segmented neutrophils, 7% lymphocytes, 2% monocytes, 2% myelocytes, 3% metamyelocytes, 2% band forms, 3% basophils, 1% atypical lymphocytes, and 75% blast-like lymphoid cells (medium to large-sized with polymorphous nucleus, prominent nucleoli, and a small quantity of basophilic cytoplasm) (Fig. 1).
(A) Giemsa-banding karyogram of bone marrow cells: 45-47,XY,-9,-11,der(14)t(11;14)(q13;q32),-22,+2~3mar. M1 and M2 indicate marker chromosome 1 and 2, respectively. (B) Single color galleries of mFISH analysis showing der(14)t(11;14)(q13;q32), der(11) t(3;11)(q25;p15)t(11;14)(q13;q32), der(14)t(8;14)(q24.1;q32), and der(17)t(8;17)(q?;q?) respectively. (C) Diagrammatic representation of der(11)t(3;11)(q25;p15)t(11;14)(q13;q32). The arrows indicate breakpoints in chromosomes 3, 11, and 14. (D) FISH analysis using a dual-color dual-fusion BCL1(green)/IGH(orange) probe, a subclone harboring 2 fusion (F), 1 BCL1(G) and 2 IGH (R) signals. The corresponding chromosomes are marked as F, G, and R on the karyogram (A).
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F2
CD19, CD20, cCD22, CD23, CD79a, HLA-DR, and kappa-restricted surface immunoglobulin, but negative for CD5, CD10, and TdT. Chromosome study revealed 45-47,XY,-9,-11,der(14)t(11;14)(q13;q32),-22,+2~3mar[cp10]/46,XY[2] (Fig. 2A). The FISH analysis revealed "nuc ish (BCL1x3),(IGHx4),(BCL1 con IGHx2)[97/300]/(BCL1,IGH)x3,(BCL1 con IGHx2)[93/300]/(BCL1x2),(IGHx3),(BCL1 con IGHx1)[31/300]/(BCL1,IGH)x2(BCL1 con IGHx1)[14/300]," showing that more than 60% of the cells harbored 2 BCL1/IGH fused signals representing the 2 derivatives (Fig. 2D). Image acquisition, processing, and evaluation were performed under a fluorescence microscope (Carl Zeiss MicroImaging GmbH, Jena, Germany) by using Isis/mFISH imaging software (MetaSystems). mFISH analysis revealed derivative chromosomes, der(11)t(3;11)(q25;p15)t(11;14)(q13;q32), der(17)t(8;17)(q?;q?), and der(14)t(8;14)(q24;q32) in 3 metaphase cells (Fig. 2B, C).