PMC5056307_01
Myeloid neoplasm with t(5;12) and ETV6-ACSL6 gene fusion: morphologic and cytogenetic features. (a) Peripheral blood with a predominant population of eosinophil precursors: large cells with mononuclear, monolobated nuclei and abundant cytoplasm containing eosinophilic granules. The predominant cell type is eosinophil myelocyte, but there is a spectrum of forms including eosinophil metamyelocytes, eosinophils bands, and mature eosinophils. Promyelocytes and myeloblasts are not observed (Wright stain, 1000x). (b) Bone marrow biopsy showing replacement of the marrow space by sheets of eosinophils and eosinophil precursors (hematoxylin and eosin, 500x). (c) Partial karyogram demonstrating t(5;12)(q31;p13) that was identified in 17 out of 20 cells cultured.
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Laboratory studies revealed hemoglobin of 7.7 gm/dL, platelet count of 84 K/cmm, and WBC of 216,000/cmm with 16% eosinophils and 68% abnormal eosinophil precursors (Figure 1(a)). The bone marrow biopsy demonstrated a markedly hypercellular bone marrow with extensive replacement of the marrow space by sheets of eosinophils in various stages of maturation with a predominance of mid-stage eosinophil forms with abnormal vacuolation, hypogranulation, hypolobation, and nuclear-cytoplasmic asynchrony (Figure 1(b)). Initial cytogenetic analysis revealed a t(5;12)(q31~33;p13) in 17 of 20 cells (Figure 1(c)) and a presumptive diagnosis of myeloid neoplasm with eosinophilia and translocation t(5;12) suggestive of PDGFRB rearrangement was made.
Summary of clinical course. The "Solid = 2 units" refers to the "Red cell Tx" and the "Platelet Tx." If the red circle is solid, this indicates that 2 units of red cells were transfused. If the green circle is solid, this indicates that 2 units of platelets were transfused.
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However, by day 24 his white cell count rose to 130,000 K/cmm (Figure 2) and he was restarted on hydroxyurea.