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Decruyenaere P, Mazure D, Moors I, Van Dorpe J, Van der Linden M, Denys B, Hofmans M, Offner F. Systemic mastocytosis with myeloid sarcoma and B-CLL: molecular and clonal heterogeneity in a rare case of SM-AHN with review of literature. Acta Clin Belg 2023; 78:58-66. [PMID: 35098906 DOI: 10.1080/17843286.2022.2033919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Systemic mastocytosis (SM) is a rare myeloproliferative disease that results from a clonal proliferation of abnormal mast cells in one or more extra-cutaneous organs. Systemic mastocytosis with an associated hematological neoplasm (SM-AHN) is the second most common subgroup and is diagnosed when WHO criteria for both SM and a hematological neoplasm of non-mast cell lineage are met. The SM-AHN category as currently proposed is highly heterogeneous in terms of pathogenesis, clinical presentation, and prognosis. CASE PRESENTATION We present the first reported case of SM-AHN associated with two hematological malignancies of different lineages, a monocytic myeloid sarcoma and a B-cell chronic lymphatic leukemia. Cytogenetic and molecular analyses revealed a distinct clonal origin of the two associated malignancies. The SM-myeloid sarcoma clone demonstrated an abnormal karyotype, trisomy 8 and del(13)(q12.3q14.3), as well as mutations in KITD816V, DNMT3A and RUNX1. The DNMT3A mutation could be detected years before disease onset, supporting its potential role as early driver of leukemogenesis. No genetic aberrations could be identified in the CLL clone, which is assumed to present coincidentally. CONCLUSIONS This report highlights the importance of full diagnostic work-up in SM patients in whom an associated hematological malignancy is suspected. Moreover, the importance of genetic analysis is highlighted, as it provides additional insights in the underlying clonal pathogenesis of different phenotypes, can aid in risk stratification, and may help identify potential therapy targets.
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Affiliation(s)
- Philippe Decruyenaere
- Department of Hematology, Ghent University Hospital, Ghent, Belgium.,OncoRNALab, Cancer Research Institute Ghent (Crig), Ghent University, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Dominiek Mazure
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Ine Moors
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | | | - Barbara Denys
- Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
| | - Mattias Hofmans
- Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
| | - Fritz Offner
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
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Wang SA, Hutchinson L, Tang G, Chen SS, Miron PM, Huh YO, Jones DM, Bueso-Ramos C, Verstovsek S, Medeiros LJ, Miranda RN. Systemic mastocytosis with associated clonal hematological non-mast cell lineage disease: clinical significance and comparison of chomosomal abnormalities in SM and AHNMD components. Am J Hematol 2013; 88:219-24. [PMID: 23440662 DOI: 10.1002/ajh.23380] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/01/2012] [Accepted: 12/06/2012] [Indexed: 11/11/2022]
Abstract
Some patients with systemic mastocytosis have concurrent hematological neoplasms, designated in the World Health Organization (WHO) classification as systemic mastocytosis with associated clonal hematological non-mast cell lineage disease (SM-AHNMD). In this study, we analyzed 29 patients with SM-AHNMD and compared them to 40 patients with pure SM. The AHNMDs were classified as chronic myelomonocytic leukemia (CMML) (n = 10), myelodysplastic syndrome (MDS) (n = 7), myeloproliferative neoplasms (n = 4), B-cell lymphoma/leukemia/plasma cell neoplasms (n = 7), and acute myeloid leukemia (n = 1). Patients with SM-AHNMD were older, more frequently had constitutional symptoms and hematological abnormalities, less often had skin lesions, and had an inferior overall survival compared with pure SM patients (48 months vs. not-reached, P < 0.001). Karyotypic abnormalities were detected in 9/28 (32%) patients with SM-AHNMD but not in pure SM patients (P < 0.001). Combined imaging/ fluorescence-in-situ hybridization performed in four SM-AHNMD cases revealed shared abnormal signals in mast cells and myeloid cells in two patients with SM-CMML and one patient with SM-MDS, but not in the mast cells of a case SM-associated with chronic lymphocytic leukemia with ATM-deletion. Quantitative mutation analysis showed higher levels of mutant KIT D816V in SM-CMML and SM-MDS than in pure SM (P < 0.001). Our data indicate that the SM-AHNMD category in the WHO classification is heterogeneous, including clonally related and unrelated forms of AHNMD. The presentation, treatment, and outcome of patients with SM-AHNMD is often dictated by the type of AHNMD.
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Affiliation(s)
- Sa A. Wang
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Lloyd Hutchinson
- Department of Pathology; University of Massachusetts Medical Center; Worcester; Massachusetts
| | - Guilin Tang
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Su S. Chen
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Patricia M. Miron
- Department of Pathology; University of Massachusetts Medical Center; Worcester; Massachusetts
| | - Yang O. Huh
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | | | - Carlos Bueso-Ramos
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Srdan Verstovsek
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - L. Jeffrey Medeiros
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Roberto N. Miranda
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
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Wang SA, Hutchinson L, Tang G, Chen SS, Miron PP, Huh YO, Jones DM, Bueso-Ramos C, Verstovsek S, Medeiros LJ, Miranda RN. Systemic mastocytosis with associated clonal hematological non-mast cell lineage disease: Clinical significance and comparison of chomosomal abnormalities in SM and AHNMD components. Am J Hematol 2013. [DOI: 10.1002/joh.23380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sa A. Wang
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Lloyd Hutchinson
- Department of Pathology; University of Massachusetts Medical Center; Worcester; Massachusetts
| | - Guilin Tang
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Su S. Chen
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Patricia P. Miron
- Department of Pathology; University of Massachusetts Medical Center; Worcester; Massachusetts
| | - Yang O. Huh
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | | | - Carlos Bueso-Ramos
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Srdan Verstovsek
- Department of Leukemia; University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - L. Jeffrey Medeiros
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
| | - Roberto N. Miranda
- Department of Hematopathology; The University of Texas M.D. Anderson Cancer Center; Houston; Texas
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Denice Smith G, Sangle NA, Wilson A, Chadwick BE, Bentz JS, Gopez EV, Pyne MT, Tripp SR, Layton M, Pasi A, Jarboe EA, Collins BT. A retrospective review of UroVysion fish interpretations over 8.6 years: A major shift in the patient test population. Diagn Cytopathol 2012; 41:437-47. [DOI: 10.1002/dc.22881] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 04/24/2012] [Indexed: 11/11/2022]
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Smith GD, Riding M, Oswald K, Bentz JS. Integrating a FISH imaging system into the cytology laboratory. Cytojournal 2010; 7:3. [PMID: 20436794 PMCID: PMC2861842 DOI: 10.4103/1742-6413.62258] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 11/12/2009] [Indexed: 11/04/2022] Open
Abstract
We have implemented an interactive imaging system for the interpretation of UroVysion fluorescence in situ hybridization (FISH) to improve throughput, productivity, quality control and diagnostic accuracy. We describe the Duet imaging system, our experiences with implementation, and outline the financial investment, space requirements, information technology needs, validation, and training of cytotechnologists needed to integrate such a system into a cytology laboratory. Before purchasing the imaging system, we evaluated and validated the instrument at our facility. Implementation required slide preparation changes, IT modifications, development of training programs, and revision of job descriptions for cytotechnologists. A darkened room was built to house the automated scanning station and microscope, as well as two imaging stations. IT changes included generation of storage for archival images on the LAN, addition of external hard drives for back-up, and changes to cable connections for communication between remote locations. Training programs for cytotechnologists, and pathologists/fellows/residents were developed, and cytotechnologists were integrated into multiple steps of the process. The imaging system has resulted in increased productivity for pathologists, concomitant with an expanded role of cytotechnologists in multiple critical steps, including FISH, scan setup, reclassification, and initial interpretation.
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Affiliation(s)
- G Denice Smith
- ARUP Institute for Clinical and Experimental Pathology , Associated Regional and University Pathologists (ARUP) Laboratories, Inc., Salt Lake City, Utah, USA
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Xu W, Cao X, Liu Q, Fan L, Miao KR, Qiu HR, Zhu DX, Qiu HX, Li JY. Trisomy 8 in two newly diagnosed Chinese patients with chronic lymphocytic leukemia. ACTA ACUST UNITED AC 2009; 192:79-81. [PMID: 19596259 DOI: 10.1016/j.cancergencyto.2009.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is one of the most common lymphoid malignancies in Western countries, but is infrequent in Asian populations. To verify the incidence of trisomy 8 in Chinese patients with CLL, fluorescence in situ hybridization (FISH) was used in 140 CLL patients after routine chromosome analysis. Only two patients (1.4%) were found with trisomy 8, and the number of trisomy 8 cells was 8 and 10%, respectively. No other aberrations by "panel" probe FISH were found in these two patients. The chromosome karyotypes of two patients were 47,XY,+8[2]/49,XY,+14,+20,+21[2]/46,XY[16] and 47,XX,+8[2]/46,XX[18], respectively. Neither of the patients' present signs of myelodysplastic or myeloproliferative disorder appeared on the bone marrow aspirates and peripheral blood smear. Our study demonstrates that trisomy 8 is rare in CLL, and its role in prognosis of CLL remains unknown.
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Affiliation(s)
- Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, China
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Cerny J, Wang S, Miron P, Hutchinson L, Brettler D. EBV-negative Hodgkin lymphoma in ZAP-70-positive B-cell lymphocytic leukemia patient. Ann Hematol 2008; 88:495-7. [PMID: 18843488 DOI: 10.1007/s00277-008-0617-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 09/23/2008] [Indexed: 12/01/2022]
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