Korean J Hematol.  2005 Jun;40(2):120-123. 10.5045/kjh.2005.40.2.120.

A Case of Promyelocytic Leukemia with Basophil-like Granules

• Jun KR
• Chi HS
• Park CJ
• Jang SS
• Lee KH

• KMID: 2252348
• DOI: http://doi.org/10.5045/kjh.2005.40.2.120

Abstract

According to the FAB (French-American-British) classification, two main cytological subtypes are recognized: the classical hypergranular and the microgranular variant. However, other morphological variants have been reported in the literature. Therefore, careful examination is needed to diagnose acute promyelocytic leukemia (APL). Herein, the case of an APL variant, with basophil-like granules, occurring in a 65 year-old woman admitted due to high fever is reported. The peripheral blood showed blasts and increased basophils. A bone marrow smear showed leukemic blasts, with irregular nuclei and coarse basophil-like granules, in the cytoplasm. Cytoplasmic vacuoles were also noted, but no Auer rod was found. The blasts showed positivity toward MPO, tryptase and toluidine blue staining. The immunophenotypes revealed a myeloid lineage, with aberrant expression of CD2 and CD7. The karyotype was t(15;17)(q22;q12) in 17 out of 20 metaphases. The RT-PCR was positive for long form PML/RARalpha transcripts. Four weeks after chemotherapy, her bone marrow status findings were in complete remission, with the karyotype converted to normal. Basophil-like granules in the blasts and promyelocytes became decreased during the course of all-transretinoic acid (ATRA) treatment. The chimeric transcript of PML/RARalpha converted to negative after consolidation chemotherapy.

Keyword

Leukemia; Promyelocytic; Acute; Variant; Basophils

MeSH Terms

Aged
Basophils
Bone Marrow
Classification
Consolidation Chemotherapy
Cytoplasm
Drug Therapy
Female
Fever
Granulocyte Precursor Cells
Humans
Karyotype
Leukemia*
Leukemia, Promyelocytic, Acute
Metaphase
Tolonium Chloride
Tryptases
Vacuoles
Tolonium Chloride
Tryptases

Figure

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  Fig. 1. Bone marrow aspiration smear reveals increased myeloblasts, basophils, and promyelocytes with basophil-like granules in some cells (Wright stain, × 1,000).

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  Fig. 2. C ytochemical stains for myeloperoxidase (A, touch print), tryptase (B, aspirate), and toluidine blue (C, aspirate) show positive reaction in promyelocytes (× 1,000).

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