Știri

A case of acute monocytic leukemia in an elderly patient

Leucemia acută monocitară este un subtip distinct de leucemie acută mieloidă, în care ≥80% din blaști aparțin seriei monocitare, având un grad variabil de maturație.
Irina Voican, Cristina Mambet, Cristina-Tatiana Enache, Andrada-Amira Voinovici, Maria-Lorena Pitiş, Ion Dumitru, Horia Bumbea, Ana-Maria Vlădăreanu, Dan Soare
24 Martie 2025
Știri
24 Martie 2025

A case of acute monocytic leukemia in an elderly patient

Leucemia acută monocitară este un subtip distinct de leucemie acută mieloidă, în care ≥80% din blaști aparțin seriei monocitare, având un grad variabil de maturație.
Irina Voican, Cristina Mambet, Cristina-Tatiana Enache, Andrada-Amira Voinovici, Maria-Lorena Pitiş, Ion Dumitru, Horia Bumbea, Ana-Maria Vlădăreanu, Dan Soare

Din aceeași categorie

Oncolog-Hematolog.ro

Tratamentul carcinomului renal metastatic cu terapiile TKI şi mTOR: prezentare de caz

Oncolog-Hematolog.ro

De actualitate în cancerul pulmonar

Oncolog-Hematolog.ro

Tratamentul cancerului gastric în spitalele judeţene, între standardul de aur şi practica clinică

A 76-year-old female patient presented in the Emergency Department of the of the Emergency University Hospital Bucharest, Romania, with fatigue, dyspnea, headache, dizziness, tender and bleeding gums.

The physical exam revealed gingival hypertrophy, palatal hematoma, and moderate hepatosplenomegaly.

Chest computed tomography with diffuse bilateral interstitial opacities was suggestive for pulmonary leukostasis.

Automatic complete blood count (CBC) indicated hyperleukocytosis (125 x 109/L), mild anemia (hemoglobin 10.1 g/dL) and severe thrombocytopenia (15 x 109/L).

Peripheral blood smear showed 85% large immature cells, most of them with folded nuclei, compatible with promonocytes (blast equivalents); only a few cells could be morphologically assigned to monoblasts (Figure 1).

Figure 1. Representative images of peripheral blood smear (100x magnification) depicting a population of large immature cells, most of them with indented or delicately folded nuclei, dispersed chromatin and nucleoli, moderate amount of blue-gray cytoplasm, finely granulated and vacuolated in some cells (promonocytes, A, B). A cell displaying round/ovalar nucleus, lace-like chromatin with nucleoli, moderate amount of basophilic cytoplasm, with vacuoles is shown in panel C (monoblast). For comparison, a normal monocyte (lobulated nucleus, condensed chromatin) is included in panel D
Figure 1. Representative images of peripheral blood smear (100x magnification) depicting a population of large immature cells, most of them with indented or delicately folded nuclei, dispersed chromatin and nucleoli, moderate amount of blue-gray cytoplasm, finely granulated and vacuolated in some cells (promonocytes, A, B). A cell displaying round/ovalar nucleus, lace-like chromatin with nucleoli, moderate amount of basophilic cytoplasm, with vacuoles is shown in panel C (monoblast). For comparison, a normal monocyte (lobulated nucleus, condensed chromatin) is included in panel D

Flow cytometry analysis performed in the peripheral blood revealed 80% blast cells, with the following phenotype: CD34-, HLA-DR+, CD33+, CD64+, CD36+, CD14+/-, CD11b+. According to the 2022 World Health Organization classification of myeloid neoplasms(1), the presence of ≥80% precursors expressing at least two monocytic markers, including CD11c, CD14, CD36 and CD64, establishes the diagnosis of acute monocytic leukemia.

Molecular testing using DNA fragment analysis detected both FLT3-ITD and NPM1 mutations.

Acute monocytic leukemia, subtype M5 in the French-American-British classification system, accounts for approximately 10% of all acute myeloid leukemia cases. Extramedullary infiltrates with monocytic blasts displaying a variable degree of maturation are relatively common, involving gums (gingival hypertrophy), skin (leukemia cutis), central nervous system, lymph nodes, liver or spleen(2,3).

NPM1 and/or FLT3-ITD mutations accompanied by marked leukocytosis leading to leukostasis are frequently encountered(4). As highlighted in the images, promonocytes should be correctly recognized and counted as blasts.   

 

Corresponding author: Cristina Mambet E-mail: cristina.mambet@gmail.com

Conflict of interest: none declared.

Financial support: none declared.

This work is permanently accessible online free of charge and published under the CC-BY licence.

leucemie acută monocitarăpromonocitehiperleucocitoză
Te-ar mai putea interesa