Korean J Pathol.  2009 Apr;43(2):189-194.

The Cytologic Features of Chronic Myelogenous Leukemia and Its Lymphoid Blast Phase in Body Fluid: A Case Report

• Im S
• Yoo C
• Lee YS
• Kang CS
• Sim SI
• Lee KY

Abstract

Although chronic myelogenous leukemia (CML) may be involved in any part of the body, infiltration of the body fluid has rarely reported in the literature. Here we report on a 35 year-old male patient who was diagnosed chronic myelogenous leukemia ten years previously and he received allogenic hematopoietic stem cell transplantation. He then presented with left knee pain eight years after the initial diagnosis. MRI revealed a soft tissue mass at the distal femur. Cytology of the joint fluid revealed myeloblasts, promyelocytes, eosinophilic myelocytes, band neutrophils, megakaryocytes and orthochromatic erythroblasts, which was all consistent with leukemic infiltration of the knee joint fluid. The immunohistochemistry was positive for CD34, CD117 and myeloperoxidase (MPO). Despite that the patient underwent radiation therapy, MRI revealed growth of the mass, and ten months later, the lymphoid blast phase of CML was confirmed after biopsy. The patient received an above knee amputation. Five months later, multiple masses were revealed on PET-CT at the left iliopsoas muscle, abdominal wall and bones. Bilateral pleural effusion occurred shortly after this. Cytologic evaluation of the pleural fluid also revealed blast-like cells, and histologic evaluation of the abdominal mass confirmed the lymphoid blast phase of CML with positivity for CD3, UCHL-1, CD34 and CD117, but negativity for MPO.

Keyword

Chronic myelogenous leukemia; Lymphoid blast phase; Body fluid; Cytology

MeSH Terms

Abdominal Muscles
Amputation
Biopsy
Blast Crisis
Body Fluids
Eosinophils
Erythroblasts
Femur
Granulocyte Precursor Cells
Hematopoietic Stem Cell Transplantation
Humans
Immunohistochemistry
Joints
Knee
Knee Joint
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemic Infiltration
Male
Megakaryocytes
Neutrophils
Peroxidase
Pleural Effusion
Peroxidase