A near haploid clone: 24,XY, t (9; 22) (q34; q11) from a patient in blast crisis of chronic myeloid leukaemia

So-called "inflammatory leiomyosarcoma'': a series of 3 cases providing additional insights into a rare entity

Inflammatory leiomyosarcoma, a rare entity first described in 1995, has been characterized by smooth muscle differentiation, a near-haploid karyotype, and a surprisingly good prognosis. The morphology is similar to that of conventional leiomyosarcoma admixed with a chronic inflammatory infiltrate. Thus far, only 15 cases have been reported in the English language literature. We report the clinical and pathological features of 3 additional cases of inflammatory leiomyosarcoma. Two women (ages 64 and 25, respectively) and 1 man (age 32) presented with a thigh, ovary, and lung mass, respectively. Inflammatory symptoms, such as anorexia, fever, night sweats, abdominal pain, and diarrhea, coincided with the thigh and ovarian primaries. Immunohistochemical studies revealed diffuse positivity for desmin and poor expression for other smooth muscle and skeletal muscle markers (muscle-specific actin [0/3], alpha-smooth muscle actin 1/3 [focal], calponin [1/3], caldesmon [0/3], and myogenin [0/3]). CD68 was diffusely positive in both the histiocytes and spindle cell component in all cases. Ultrastructural evaluation of 1 case (lung primary) lacked definitive smooth muscle differentiation. Cytogenetic analysis in 1 of 2 cases that were karyotyped, identified a near-haploid karyotype, which has been reported in other cases of inflammatory leiomyosarcoma. The other case showed 2 clonal populations of cells with interstitial deletions of the short arm of chromosome 8 and the long arm of chromosome 9, respectively. The case without cytogenetic data was intimately associated with an ovarian mature teratoma. These data also suggest that inflammatory leiomyosarcoma may lack smooth muscle differentiation, characterized by diffuse immunoreactivity for desmin but lack of immunoreactivity for alpha-smooth muscle actin, calponin, and caldesmon. In addition, 2 of the 3 cases developed distant metastases to the lungs, which suggests that these lesions may have a worse prognosis than previously believed.

A near-haploid bone marrow karyotype in systemic mast cell disease: is it characteristic of the disease or an incidental finding?

We present the case of a 40-year-old man with aggressive systemic mast cell disease. The patient had a predominant near-haploid clone in his bone marrow cells, detected by cytogenetic analysis performed at the time of diagnosis. The similarities between this case and a previously published case of near-haploidy in a patient with malignant mastocytosis suggest that near-haploidy may be a characteristic of aggressive systemic mast cell disease rather than an incidental finding.

Near-haploid karyotype in a squamous cell lung carcinoma

Cytogenetic analysis of a squamous cell lung carcinoma revealed a near-haploid karyotype with 27 chromosomes, in both primary cultures and an established cell line. The only chromosomes with two homologs present were chromosomes X, 5, 7, and 22. The two X chromosomes were early and late replicating, respectively. No structural rearrangements could be detected. In vitro, the clone evolved by duplication towards hyperdiploidy with 54 chromosomes.

Cytogenetic and flow cytometric analysis of a clear cell chondrosarcoma

Cytogenetic analysis of a rare tumor, a clear cell chondrosarcoma of the spine, showed unusual karyotypic findings. The tumor had a predominant clone with a near-haploid chromosome complement of 30 chromosomes with loss of one homologue of each chromosome pair except chromosomes 5, 7, 12, and 19-22. A second clone with 58-60 chromosomes appeared to have originated by a doubling of the near-haploid clone. No structural changes were present. Comparison with other solid tumors and leukemias with near-haploid chromosome complements showed an interesting difference in the chromosomes which were preferentially disomic or monosomic in the two groups. Quantitative DNA analysis also showed aneuploid clones of cells corresponding to the near-haploid and hyperdiploid chromosome counts obtained cytogenetically.

Near-haploid cell line in megakaryoblastic transformation of Philadelphia-positive chronic myeloid leukemia

A case of near haploidy in a patient with an acute megakaryoblastic transformation of Philadelphia (Ph)-positive chronic myeloid leukemia (CML) was studied. Cytogenetic studies revealed persistence of a Ph-positive pseudodiploid cell line and the emergence of a Ph-positive near-haploid cell line, i.e., 46,XX,t(9;22)(q34;q11)/28,XX,t(9;22),+8,+14,+18,+29. The near-haploid cell line is a rare cytogenetic finding. The patient rapidly deteriorated and died.

Origin of near-haploidy in malignant hematopoietic cells

Hyperdiploidy is common in neoplastic diseases but severe hypodiploidy or near-haploidy is extremely rare. Acute lymphocytic leukemia (ALL) and blast phase of chronic myelocytic leukemia (BC/CML) are the two most common leukemias where metaphases with as low as 23 chromosomes have been reported. Recent studies have indicated that during the course of malignant development, cells undergo numerous changes, however, it is still not known whether malignant transformation proceeds or results from the near-haploid state. Retrospectively, we have examined 100 metaphases with chromosome counts of 23 to 35 in patients with CML who have not yet progressed to the blastic phase, to see whether such metaphases share any common characteristics with published cases. The unusual behavior of chromosomes 8, 17 and the presence of Ph-chromosomes in 85% of the cells are highly unique features in our study. These observations are compatible with those found in BC/CML patients reported earlier. Therefore, it is hypothesized that selective chromosome loss is a gradual phenomenon and one of these near-haploid clones may replace a diploid clone as the dominant component of the population during blast transformation. Several hypotheses are proposed as to the origin of such clones in malignant hematopoietic stem cells.

Two apparent Philadelphia chromosomes arising from translocations with different chromosomes in a patient with CML: 46,XY,t(7;22)(p22;q11),t(9;22)(q34;q11)

Chromosome studies on bone marrow cells and unstimulated peripheral lymphocytes from a patient with chronic myelogenous leukemia revealed the presence in all cells of two apparent Philadelphia chromosomes: one resulting from the classical translocation with a chromosome #9, and the other arising from a translocation between chromosomes #22 and #7. There was no normal chromosome #22. Some of the cells also had an i(17q), indicative of blast crisis. Repeated chromosome studies at different times during the course of the disease revealed the evolution of additional karyotypic changes. All cells from later samples had an extra #8; some of these cells had a third Philadelphia chromosome, whereas, others had a second Y chromosome. Although a few normal cells were seen in PHA-stimulated lymphocyte cultures, indicating that the patient has a normal constitutional karyotype, most of the cells had a karyotype identical to that found in unstimulated cultures. This unusual karyotype, 46,XY,t(7;22)(p22;q11),t(9;22)(q34;q11), represents the first case in which two apparent Philadelphia chromosomes are present in the leukemic cells from a patient in the absence of a normal #22 chromosome.

Near-haploidy in a case of plasmocytoma

Chromosome studies of a solitary plasmocytoma in the femoral bone revealed a near-haploid chromosome number of 31-32 with a loss of one homolog of each chromosome pair except #1, #7, #9, #15, #19-21, and the sex chromosomes (XY). The cytogenetic findings have been compared with 16 cases of near-haploid neoplasms from the literature studied using banding techniques. A common feature present in 13 of the 16 cases reported was found to be disomy 21; the only chromosomes consistently present in one copy in all neoplasms were #2, #3, #4, and #5.

A case of acute lymphoblastic leukemia with severe hypodiploidy

A case of acute lymphoblastic leukemia with a severe hypodiploid chromosome constitution is reported. The modal chromosome number was 36, and the karyotype of these cells was 36,X, -X, -2, -3, -5, -7, -9, -12, -13, -15, -16, -17, -20, +21, +mar,del(1) (p13.1p22.3),inv(3)(q13.3q29). In addition to a haploid set, extra copies of chromosomes #6, #10, #14, #18, and #21 were found, as in most cases with severe hypodiploid karyotypes. A second, near-triploid cell line was also observed. An examination of chromosomal heteromorphisms suggested that the severe hypodiploid clone originated either from a near-triploid cell or from a common precursor cell.

Chromosomal characteristics of chronic and blastic phases of Ph-positive chronic myeloid leukemia

To evaluate the appearance of chromosome changes, in addition to the Philadelphia (Ph) chromosome, as predictive and diagnostic parameters of transformation in chronic myeloid leukemia (CML), such changes were analyzed in the chronic phase (CP) and compared with those of the blastic phase (BP) of CML. The common chromosome changes observed in the CP were loss of a Y (-Y), trisomy 8 (+8), an isochromosome for the long arm of chromosome #17 [i(17q)], a double Ph (+Ph), reciprocal translocations, and partial deletions. In most patients with chromosome changes in addition to the Ph, the percentage of abnormal clones increased steadily during the CP and was accompanied by other chromosome changes shortly before or at the onset of the BP, except for cases with -Y or i(17q) clones. In general, most chromosome changes observed shortly before or at the BP were complex. These facts suggest that complex chromosome changes could be utilized as predictive and diagnostic parameters of blastic transformation in CML.

24-36-Chromosome clones in human malignancies. Cytogenetic interrelationships, clinical significance and patient age

The literature has been reviewed for cases of malignant disease showing cellular clones with 24-36 chromosomes. Such cases are characterized by aggressive disease. Together the clones with 24-36 chromosomes compose a remarkably consistent non-random cytogenetic pattern, which demonstrates that different chromosomes are of different value for cellular survival and clonal propagation. Considering that the tissues of origin are very different (various solid tumours and different leukaemias), the close mutual cytogenetic relationship between the clones indicates that the cytogenetic pattern is tissue non-specific. Karyotypic non-specificity of cells with very different phenotypes is an apparent contradiction, which raises important questions concerning the relation between karyotype and phenotype.

Near-haploid cell line in the blastic crisis of chronic myelogenous leukemia: a possible marker for lymphoid malignancy

The blast cells of a 14-year-old patient in the blastic phase of chronic myelogenous leukemia (CML) were studied. Cellular morphology, presence of the enzyme terminal deoxynucleotidyl transferase (TdT), and reactivity to the common acute lymphoblastic leukemia antiserum (CALLA) substantiated a lymphoid blast cell line. Immunologic surface markers were nonreactive for E-rosette (T) cells and immunoglobulin-bearing (B) cells. Cytogenetic, studies revealed persistance of the Philadelphia chromosome and a near-haploid cell line, i.e., 28,XY,t(9;22), +14, +15, +21, +22(GTG). The patient responded to chemotherapy with vincristine, prednisone, and L-asparaginase, first line drugs used for remission-induction of acute lymphoblastic leukemia in childhood. We suggest that severe hypodiploidy or near-haploidy, along with TdT and CALLA, may provide more accurate prognostic information in patients with CML and the lymphoid blastic crisis.

Extreme hypodiploidy in a case of myelomonocytic crisis of chronic myelogenous leukemia

Two cytogenetically distinct populations of marrow cells were observed in a 28-year-old woman who developed a fulminant blastic crisis (BC) of chronic myelogenous leukemia (CML) after only 1 year in the chronic phase: one population with 35-36 chromosomes, the other showing 66-72 chromosomes. Cytochemical investigation demonstrated a myelomonocytic type of BC. Chromosome banding and correlation analysis of the mean karyotypes of the two populations showed that a close relationship existed between them, indicating that one population had developed from the other. The cytogenetic evidence suggests but does not prove that the cells with triploid chromosome numbers developed from the extremely hypodiploid population by duplication of the chromosome complement. The extreme cytogenetic diversity of both populations indicates that each was undergoing further cytogenetic evolution.

Chromosomes and causation of human cancer and leukemia. XLVII. severe hypodiploidy and chromosome conglomerations in ALL

A case of acute lymphoblastic leukemia (ALL) of the L1 type with severe hypodiploidy in the marrow cells (modal chromosome number, 36) is described. In addition, most of the metaphases contained chromosome conglomerations which consisted of varying numbers of chromosomes and appeared similar to conglomerations previously observed by us in a case of chronic myelocytic leukemia (CML) in the blastic phase (BP), where some cells contained less than 20 chromosomes. The karyotype of the ALL cells of our case was similar to those of published near-haploid ALL cases, possibly indicative of a common pathway of cytogenetic evolution.

Acute lymphocytic leukemia with microblastosis and near haploidy (26 chromosomes): a case report

A three-year-old acute lymphocytic leukemia (ALL) patient had a modal chromosome count of 26 in her bone marrow metaphases. The leukemia was "common" ALL by cytochemical and immunologic studies. Five other cases had been reported previously, and all have had a near haploidy varying from 26 to 32 chromosomes. Disomy of chromosomes 18 and 21 is a consistent feature of this disease. Severe hypodiploidy correlates with microblastosis requiring morphologic separation from non-neoplastic small lymphocytes.

Chromosomal findings and their correlation to prognosis in acute lymphocytic leukemia

Sixteen of the 17 patients with acute lymphocytic leukemia (ALL) were revealed to have chromosome abnormalities in their leukemic cells. Of nine children, six had modal chromosome numbers between 50 and 59; these patients and one additional patient with a pseudodiploid karyotype have achieved and retained a complete remission. The only patient without chromosome abnormalities achieved a remission, but had a relapse and died. The only child who expired without achieving a remission had 47 chromosomes in his leukemic cells. Of eight adults, none had the hyperdiploidy seen in the children. The four with hypo-or pseudodiploidy failed to achieve a complete remission. One patient had 47 chromosomes in his leukemic cells, and this patient and the remaining three, all with ploidy abnormalities, achieved a complete remission, but a relapse occurred and they died. The chromosomal abnormalities were very extensive in most cases, many patients having marker chromosomes of an unknown origin. Four patients clearly exhibited karyotypic evolution when they relapsed. The patients with hyperdiploidy had a better prognosis, and those with pseudodiploidy had a poorer prognosis. The role of individual chromosome aberrations, however, remains to be elucidated.

Cytogenetic analysis and flow cytometric DNA measurement of a human tumor with pronounced hypodiploidy

A case of malignant choroid plexus papilloma of the brain with severe hypodiploidy is presented. The hypodiploidy was estimated by means of flow cytometric measurements of the nuclear DNA content in two investigations with an interval of 21 months. The latter investigation was supplemented with chromosome analyses including quinacrine bonding. A modal chromosome number of 34 to 35 was found with a consistent loss of one chromosome Nos. 2, 3, 4, 5, 10, 13, 14, 15, 17, and 18, and no major structural changes. The corresponding calculated DNA content per nucleus correlated very well with the measured content, which was found to be 75% of the male diploid amount. The paper briefly discusses cell survival in extreme hypodiploidy and provides a comparison with cases from the literature in which banding analysis gives comparable information.

Chromosomes and causation of human cancer and leukemia: XXXIX. Usual and unusual findings in Ph1-positive CML

The chromosomal changes in the leukemic cells of 48 patients with Ph1-positive CML are reported. The karyotypic findings in the chronic phase (CP) and blastic phase (BP) were similar to those reported in the past, with +8, and extra Ph1, and an iso (17q) being the most common anomalies observed in BP. Unusual cytogenetic findings were observed in one patient whose cells (from lymph nodes, bone marrow, and blood) were characterized by very marked hypodiploidy and hypo-haploidy, with some of the cells having less than 20 chromosomes. In each of these very hypodiploid metaphases, conglomerations of darkly stained and condensed chromosomes were seen. These conglomerations consisted of a few to eight chromosomes. The role played by these chromosomes in the genesis of severe hypodiploidy is uncertain. The patient was thought to have "lymphoid" types of leukemic cells in BP, with an extramedullary origin of such cells, particularly in lymph nodes, playing a major role in the genesis of BP. The reported cases of near-haploidy with Ph1-positive CML and those with constitutional translocations with CML have been tabulated and the possible significance of the cytogenetic abnormalities discussed.