Korean J Hematol.  2012 Sep;47(3):225-228. 10.5045/kjh.2012.47.3.225.

A case of therapy-related acute myeloid leukemia with inv(16)(p13.1q22) after single low-dose iodine-131 treatment for thyroid cancer

• Jeong JH
• Ahn JY
• Park SH
• Park MJ
• Kim KH
• Hong JS

• KMID: 2251958
• DOI: http://doi.org/10.5045/kjh.2012.47.3.225

Abstract

Radioiodine is regularly used in the treatment of thyroid cancer to eliminate residual malignant tissue after thyroidectomy and to treat metastasis. Because of the low dose of radioiodine used to treat thyroid cancer patients, leukemia is an uncommon complication of exposure to radioiodine. Here, we present a patient who developed therapy-related acute myeloid leukemia with inv(16)(p13.1q22);CBFbeta-MYH11, eosinophilia, and K-ras mutation and who had been treated with very low-dose radioiodine following total thyroidectomy.

Keyword

Radioiodine; Thyroid cancer; Acute myeloid leukemia; CBFbeta-MYH11; Eosinophilia; K-ras

MeSH Terms

Eosinophilia
Humans
Leukemia
Leukemia, Myeloid, Acute
Neoplasm Metastasis
Oncogene Proteins, Fusion
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Oncogene Proteins, Fusion

Figure

• 

  Fig. 1 Morphologic and cytogenetic study. (A) Peripheral blood smear and (B) bone marrow aspirates show myeloblasts, immature monocyte precursors, and abnormal eosinophils. The eosinophil count is markedly increased (53.4%), and some eosinophils have basophilic granules (Wright Giemsa stain ×1,000). (C) Blasts are positive for myeloperoxidase (MPO). (D) The marrow monocytic component is stained by α-naphthyl-butyrate esterase. (E) The karyotype reveals 46,XX,inv (16)(p13.1q22)[20] (GTL banding, ×1,000). (F) FISH using a LSI CBFB Dual Color Break Apart Rearrangement Probe reveals separate red (5' CBFB gene) and green (3' CBFB gene) signals, resulting in distinct hybridization signals on the arm of the inverted chromosome 16, and these signals were expressed in more than 89% of the cells. The normal CBFB allele is seen as one fused red-green (yellow) signal.

• 

  Fig. 2 K-ras mutation by pyrosequencing. Pyrogram shows the mutation and mutated clones. The X axis means the base and the Y axis represents the intensity of fluorescent signal. Shaded regions represent K-ras codons 12 and 13. (A) Arrow shows the analytic results of substitutions in the second base of K-ras codon 12. The mutation GGT (Gly) to GAT (Asp) in codon 12 was detected by pyrosequencing. (B) After induction of chemotherapy, the K-ras mutation disappeared.

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