PMC7787850_01
Bone marrow morphology: increased blasts, promonocytes, and atypical eosinophils with large basophilic granules.
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Importantly, there were increased eosinophils that had increased and coarse basophilic granules (Figure 1).
Representative G-banded karyogram showing (a) the inv(16)(p13.1q22) as a sole abnormality and (b) co-occurrence of inv(16)(p13.1q22) and t(9;22)(q34; q11.2). The arrows indicate the rearranged chromosomes.
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Two metaphases had pericentric inversions of chromosome 16 (Figure 2(a)). The second related clone was observed in majority of the metaphases, and each had a Philadelphia chromosome with the classic (9;22) translocation along with an inversion 16 abnormality (Figure 2(b)).
Fluorescence in situ hybridization (FISH) studies on interphase cells showing (a) CBFB and MYH11 rearrangement, dual fusion probe (Cytocell); (b) BCR/ABL1 translocation, dual fusion probe (Cytocell); and (c) normal FISH signal pattern for RUNX1T1/RUNX1 rearrangement, dual fusion probe (Abbott molecular).
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Fluorescence in situ hybridization (FISH) assays were positive for CBFB rearrangement and BCR/ABL1 translocation in 94.0~95.0% of the interphase nuclei (Figures 3(a) and 3(b)). A FISH assay for rearrangement of RUNX1T1/RUNX1 was normal (Figure 3(c)).
Fusarium infection presenting as a skin ulceration in his toes.
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Notably on day 20, the patient's clinical course was complicated by a skin ulceration in his toes that later resulted in disseminated Fusarium infection (Figure 4).
(a) Fluorescence in situ hybridization (FISH) studies on interphase cells showing BCR and ABL1 FISH probe signals, dual fusion probe (Cytocell) and (b) representative G-banded karyogram showing relapsed clone of the inv(16)(p13.1q22) primary clone.
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FISH and RT-PCR); however, the inv(16) clone resurfaced with other additional abnormalities significant for clonal evolution (Figure 5). Fungitell values were again high, and CT scan showed findings consistent with pneumonia and pansinusitis.