Chromosomes and causation of human cancer and leukemia. LI. A hairy cell leukemia case with 14q+ and ring chromosomes: significance of ring chromosomes in blood disorders

Deciphering the genotype and phenotype of hairy cell leukemia: clues for diagnosis and treatment

Introduction: Hairy cell leukemia (HCL) is a rare, indolent B-cell neoplasm. The classical variant of the disease is characterized by the BRAF V600E mutation, which is present in virtually all cases. How this mutation leads to the signs and symptoms of the disease is currently not known. Areas covered: This review explores the genetic background of HCL, especially the BRAF V600E driver mutation, but passenger mutations and their effects are also included. The clinical significance of BRAF mutations in other cancer types is discussed, as well as BRAF- induced senescence. An overview of the major forms of treatment of HCL (cytostatic drugs, specific BRAF inhibitors, B cell-specific antibodies) is given. Finally, possible mechanisms of the monocytopenia and hairy morphology so typical of this disease are discussed. Expert opinion: Although being a rare disease, HCL and its pathogenesis can yield important information about BRAF-related cancer metabolism. Many aspects of the disease are still unclear, but with the right resources, this could change. This can lead to a more efficient and specific treatment, thus leading to decreased morbidity.

Human fetal/tumor metakaryotic stem cells: pangenomic homologous pairing and telomeric end-joining of chromatids

Metakaryotic cells and syncytia with large, hollow, bell-shaped nuclei demonstrate symmetrical and asymmetrical amitotic nuclear fissions in microanatomical positions and numbers expected of stem cell lineages in tissues of all three primordial germ layers and their derived tumors. Using fluorescence in situ hybridization, mononuclear metakaryotic interphase cells have been found with only 23 centromeric and 23 telomeric staining regions. Syncytial bell-shaped nuclei found approximately during weeks 5-12 of human gestation display 23 centromeric and either 23 or 46 telomeric staining regions. These images suggest that (1) homologous chromatids pair at centromeres and telomeres, (2) all paired telomeres join end-to-end with other paired telomeres in all mononuclear and some syncytial metakaryotic cells, and (3) telomere junctions may open and close during the syncytial phase of development. Twenty-three telomeric joining figures could be accounted by 23 rings of one chromatid pair each, a single pangenomic ring of 23 joined chromatid pairs, or any of many possible sets of oligo-chromatid pair rings. As telomeric end-joining may affect peri-telomeric gene expression, a programmed sequence of telomeric end-joining associations in metakaryotic stem cells could guide developmental arboration and errors in, or interruptions of, this program could contribute to carcinogenesis.

Clonal chromosome rearrangements in hairy cell leukemia: personal experience and review of literature

Cytogenetic studies in hairy cell leukemia (HCL) are rare. In the present report, cytogenetic investigations were performed on marrow cells obtained from 21 HCL male patients with a mean age of 57 years and active disease. Karyotypic analysis was successful in 18 of the 21 patients, either at diagnosis or in relapse after treatment with IFNa. Clonal chromosome abnormalities were detected in eight of 18 cases. The chromosome most frequently involved in the rearranged karyotypes was chromosome 14. Results are discussed with respect to 79 abnormal HCL cases obtained from an extensive review of the literature from 1978 to 2000.

The characterization of chromosomal rearrangements by a combined micro-FISH approach in a patient with myelodysplastic syndrome

We report the application of a combined strategy: chromosome microdissection, degenerate oligonucleotide primed-PCR, and reverse chromosome painting (micro-FISH), as well as forward chromosome painting, for the characterization of chromosomal rearrangements in a MDS patient with the karyotype 46,XX, -11, +r analyzed by G-banding. The karyotype was refined as 46,XX,der(2)t(2;11) (q35;?p13),der(11)dic r(11)(:p13-->q13::p13-->q13:). Our study demonstrated that the chromosome composition of a neoplasia can be identified more systematically and accurately using these combined molecular cytogenetic approaches. The DOP-PCR methodology modified is suitable for the practical application of micro-FISH on specimens prepared for routine banding analysis.

Primary central nervous system lymphomas. Immunophenotypic, virologic, and cytogenetic findings of three patients without immune defects

BACKGROUND

Primary central nervous system (PCNS) lymphoma is a relatively rare disease, but an increasing incidence is reported. The Epstein-Barr virus (EBV), which is often found in lymphomas of immunocompromised patients, has been implicated in the development of lymphomas. Many cytogenetic analyses of nodal B cell lymphomas have been performed, but few studies on PCNS lymphomas have been reported.

METHODS

The detection of EBV genome using the polymerase chain reaction (PCR) method and cytogenetic studies were performed, in addition to histopathologic and immunophenotypic approaches in biopsied tissue from three patients with PCNS lymphoma. Immunosuppressive states and exposure to mutagens were not clear in all patients.

RESULTS

Histopathologic examination disclosed a diffuse type of malignant lymphoma in all patients. Immunophenotypic studies revealed B cell phenotype in all patients, two of whom showed positive reaction for CD5. The PCR method revealed no involvement of EBV genome in tumors in any patients. The cytogenetic study showed clonal chromosome abnormalities in all patients, and abnormalities of chromosome 1 (1q21), 6 (-6, 6q15 and 6q21), 7 (-7 and 7p15), and 14 (14q24 and 14q32) were prominent. The t(6;14)(q15;q32) observed in Patient 1 is the first case to be reported in human de novo lymphoma.

CONCLUSIONS

These findings indicate that the causative role of EBV in PCNS lymphoma without immune defects is not clear. The cytogenetic findings were similar to those observed in nodal B-cell lymphoma, suggesting that the origin of PCNS lymphoma cells does not differ from nodal B cell lymphoma cells cytogenetically.

Ring chromosomes in hypodiploid and hypotetraploid clones from an elderly patient with plasma cell leukemia

We describe a 77-year-old woman who had with what appears to be the first case of plasma cell leukemia (PCL) with a ring chromosome of variable size. Of the three clones evident, two of them were abnormal: a 41,X,-X hypodiploid clone with rings of two different sizes, and a 81-82,XX hypotetraploid clone with a double-sized dicentric ring or variable double rings. Additional structural and numerical abnormalities included a 14q+ marker, deletions of two chromosomes 1 and monosomies 8 and 13, all previously reported in PCLs. Ring chromosomes have been associated with a poor prognosis, especially in elderly patients. The patient declined active treatment and died within 4 weeks of diagnosis.

Ring chromosomes in chronic myelogenous leukemia: an ominous finding

Two cases of Philadelphia chromosome positive chronic myelogenous leukemia (CML) demonstrated ring chromosomes. The appearance of the ring coincided with evolution from the stable to the aggressive phase. A literature search yielded six other cases of ring chromosomes in CML; all were in or were entering the aggressive phase of the disease. Thus, as is the case with acute nonlymphocytic leukemia, in CML the finding of an acquired ring chromosome is associated with a poor prognosis.

Cytogenetic studies in hairy cell leukemia

Cytogenetic analyses were performed on cells from 17 patients with hairy cell leukemia stimulated with polyclonal B-cell activators (in 155 different cultures). No mitosis was obtained in samples from four cases (23.5%). Of 14 bone marrows, four (28.6%) showed mitoses, two with clonal abnormalities. All four samples from the spleen had mitoses with four clonal changes; eight of 13 (37.5%) blood samples had mitoses with three clonal changes. Of the polyclonal B-cell activators (PBA), lipopolysaccharide and protein A seemed to be effective for the detection of clonal abnormalities in hairy cell leukemia. Among the clonal aberrations, chromosomes #3, #10, and #17 were affected in two cases each; frequent numerical changes were monosomies of #10 and #17 and structural changes were deletions at band 3p21 (two cases), 6q-, and der(9)t(9;?)(p22;?). The chromosomal bands involved in structural changes were close to accepted constitutive fragile sites.

Ring chromosomes and hematologic disorders

Based on 5 years of cytogenetic evaluation in hematology, we report our observations on various hematologic proliferative disorders with ring chromosomes. Comparing our data to those previously published in the literature we analyzed the occurrence of the ring in relation to the age of onset, previous history of therapeutic or professional exposure to mutagenic agents, and mean survival. It is concluded that the presence of ring chromosomes may be linked to a poor prognosis.

14q+ in Ph-positive chronic myelogenous leukemia

Two cases of chronic myelogenous leukemia with a Ph translocation and an additional chromosome change of the long arm of a chromosome #14 (14q+) are reported. The breakpoints on chromosome #14 were identified as 14q24 and 14q32, respectively. One of the patients did not show any evidence of blastic transformation; the other patient developed a myeloid blastic crisis when the abnormal 14q+ was seen in the bone marrow cells.

Cytogenetic studies of stimulated lymphocytes in hairy cell leukemia

Using a sister chromatid differentiation (SCD) technique, cell cycle analysis in lymphocytes from two patients with hairy cell leukemia (HCL) revealed it to be similar to cell cycle progression of normal lymphocytes stimulated with lipopolysaccharide W from Escherichia coli 0.55:B5 (LPS). It appears that LPS can readily stimulate the leukemic cells of HCL into mitosis. In the two cases of B cell HCL studied, one (case 1) was revealed to have an abnormal clone with a missing chromosome #22 that was related to the production of lambda-chains.

Del(3)(p13) in B-prolymphocytic leukemia--a new nonrandom chromosomal aberration possibly related to the c-ras oncogene

Cytogenetic analysis was performed on the leukemic cells from two patients with B-prolymphocytic leukemia. Both patients had del(3)(p13) chromosomal abnormality, as well as other clonal aberrations. Del(3p) was previously reported in one case of B-cell prolymphocytic leukemia, and is known to be a specific aberration in small-cell carcinoma of the lung. In B-cell prolymphocytic leukemia, as in other B-lymphocytic leukemias/lymphomas, the karyotype often involves chromosomes #3, #6, #11, and #12. All of these chromosomes are suggested sites for the c-ras oncogene family.

Chromosomes and causation of human cancer and leukemia. LII. Chromosome findings in treated patients with B-cell chronic lymphocytic leukemia

The chromosomes of stimulated lymphocytes in 40 treated cases of B-cell chronic lymphocytic leukemia (B-CLL) were examined. The polyclonal B-cell activators (PBA) used were: pokeweed mitogen (PWM), Epstein-Barr virus (EBV), and lipopolysaccharide W from Escherichia coli 055:B5 (LPS). Thirty-three (83%) of the 40 cases contained an adequate number of metaphases that were suitable for banding. Of 15 cases with abnormal clones, 7 cases had trisomy #12. Occasionally, trisomy #1, 6q-, i(7q), 14q+, trisomy #16, and trisomy #18 were seen. In 5 cases, marker chromosomes of unknown origin existed. The findings indicate that trisomy #12 may be a unique and nonrandom karyotypic change in B-CLL.