1
|
Haba A, Imaizumi Y, Hayashi D, Yasue S, Otsuka H, Endo S, Ozeki M, Kobayashi K, Miyazaki T, Hara A, Ohnishi H. Detection of transient abnormal myelopoiesis blasts in a liver biopsy specimen by double-immunostaining for full-length GATA1 and CD42b. Hematology 2023; 28:2240135. [PMID: 37489937 DOI: 10.1080/16078454.2023.2240135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Transient abnormal myelopoiesis (TAM) is characterized by leukocytosis with increased circulating megakaryoblasts that harbor N-terminal truncating mutations in the GATA1 gene. Approximately 10% of affected patients experience early death. OBSERVATIONS A 2-month-old boy with Down syndrome was diagnosed with TAM and followed without treatment. Although the blasts in the peripheral blood disappeared, liver failure progressed. A pathological examination revealed liver fibrosis, and double-immunostaining for full-length GATA1 and CD42b identified megakaryocytes with a GATA1 mutation. CONCLUSIONS This simple and cost-effective method can be applied in routine practice to detect TAM blasts during assessment in a TAM crisis.
Collapse
Affiliation(s)
- Azusa Haba
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuko Imaizumi
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Daichi Hayashi
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shiho Yasue
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroki Otsuka
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Saori Endo
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiro Kobayashi
- Department of Diagnostic Pathology, Gifu University Hospital, Gifu, Japan
| | - Tatsuhiko Miyazaki
- Department of Diagnostic Pathology, Gifu University Hospital, Gifu, Japan
| | - Akira Hara
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hidenori Ohnishi
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
2
|
Geetha SD, Singh R, Shaham M, Cohen N, Sticco K. Transient abnormal myelopoiesis with extramedullary involvement in a down syndrome preemie leading to an unresponsive course despite chemotherapy. Leuk Res Rep 2023; 20:100381. [PMID: 37560406 PMCID: PMC10407260 DOI: 10.1016/j.lrr.2023.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/01/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Transient abnormal myelopoiesis (TAM) is a transient, clonal myeloproliferative disorder unique to Down Syndrome (DS) babies. It is characterized by increased peripheral blasts and presence of GATA1 mutation. The clinical spectrum ranges from jaundice and hepatosplenomegaly to multi-organ failure and death. Here we present a case of a premature baby with DS diagnosed to have TAM with extramedullary involvement at birth who had a fatal outcome. CASE REPORT A 30.3-week-old female fetus with DS had leukocytosis (WBC: 187.82 K/uL) with neutrophilia (ANC 27.65 K/uL), macrocytic anemia (RBC: 2.41 m/uL, Hb 8.8 g/dL, MCV 108.3, MCH 36.5, MCHC 33.7) and thrombocytosis (platelet count 361 K/uL) at birth. Liver panels demonstrated normal bilirubin levels with elevated liver enzymes (AST = 239 U/L, ALT = 216 U/L). RESULTS Peripheral smear showed marked leukocytosis with increased blasts (70%), nucleated RBCs, giant platelets, and megakaryocytic elements. Flow cytometry demonstrated two populations of cells: 20% myeloblasts and 26% dim CD45 CD34- cells. GATA1 mutation was present. Based on these findings a diagnosis of TAM with extramedullary hematopoiesis was made. She received two cycles of cytarabine chemotherapy. Though her WBC levels reached a low of 18.93 K/uL, she developed multi-organ failure, eventually leading to death on day 45. DISCUSSION TAM is a transient condition resulting in disease resolution in around 80% of cases. Death is reported in 10% of cases. Risk factors associated with early death include prematurity, hyperleukocytosis, elevated bilirubin levels. Management of high-risk babies with chemotherapy is recommended to improve survival.
Collapse
Affiliation(s)
- Saroja Devi Geetha
- Department of Pathology and Laboratory Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 2200 Northern Blvd, Suite 104, Greenvale, NY 11548, United States
| | - Ram Singh
- Cytogenetics Laboratory, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, United States
| | - Meira Shaham
- Cytogenetics Laboratory, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, United States
| | - Ninette Cohen
- Cytogenetics Laboratory, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, United States
| | - Kristin Sticco
- Department of Pathology and Laboratory Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 2200 Northern Blvd, Suite 104, Greenvale, NY 11548, United States
| |
Collapse
|
3
|
Yin L, Lovell MA, Wilson ML, Wei Q, Liang X. Distinct GATA1 Point Mutations in Monozygotic Twins With Down Syndrome and Transient Abnormal Myelopoiesis From a Triplet Pregnancy: A Case Report and Review of Literature. Am J Clin Pathol 2016; 146:753-759. [PMID: 28028114 DOI: 10.1093/ajcp/aqw190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Down syndrome (DS)-associated transient abnormal myelopoiesis (TAM) or acute megakaryoblastic leukemia (AMKL) in monozygotic twins is exceedingly rare and has not been well characterized. METHODS We describe a unique case of monozygotic twins with simultaneous TAM from a triplet pregnancy at 34 weeks' gestation. Previously reported cases of TAM and DS-AMKL in monozygotic twins have been reviewed to compare with our cases. The current concept of a sequential multistep process in leukemogenesis and disease evolution of TAM into DS-AMKL through the collaboration among trisomy 21, GATA1, and other gene mutations is also reviewed. RESULTS Distinct GATA1 mutations are identified in our neonate twins with TAM from a triplet pregnancy, whereas precisely identical GATA1 mutations have been detected in all three monozygotic DS twins reported in the literature. CONCLUSIONS Identical GATA1 mutations in cases of monozygotic twins are likely derived from twin-twin transmission. Distinct GATA1 mutations identified in our neonate twins with TAM provide unequivocal evidence of independent intra-utero GATA1 mutations, a completely different mechanism of development of TAM in monozygotic twins from previously reported cases. Interaction of trisomy 21 and GATA1 mutation produces TAM, but additional gene mutations are required for TAM to transform into DS-AMKL.
Collapse
Affiliation(s)
- Liqun Yin
- From the Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora
| | - Mark A Lovell
- From the Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora
- Department of Pathology,, Denver Health Medical Center, Denver, CO
| | - Michael L Wilson
- From the Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora
- Department of Pathology, Children's Hospital Colorado, Anschutz Medical Campus, Aurora
| | - Qi Wei
- Department of Pathology, Children's Hospital Colorado, Anschutz Medical Campus, Aurora
| | - Xiayuan Liang
- From the Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora
- Department of Pathology, Children's Hospital Colorado, Anschutz Medical Campus, Aurora
| |
Collapse
|
4
|
Raj A, Talukdar S, Das S, Gogoi PK, Das D, Bhattacharya J. Congenital leukemia. Indian J Hematol Blood Transfus 2014; 30:159-61. [PMID: 25332567 PMCID: PMC4192207 DOI: 10.1007/s12288-013-0307-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/24/2013] [Indexed: 11/26/2022] Open
Abstract
Congenital leukemia is a rare but a well-documented disease in which leukemic process is detected at birth or very shortly thereafter (Philip McCoy and Roy Overton, Commun Clin Cytom 22:85-88, 1995). These leukemias represent approximately 0.8 % of all childhood leukemias. We present a case of congenital acute myeloid leukemia manifesting from the very first day of birth. Diagnosis of acute myeloid leukemia was suspected by the presence of blasts in the peripheral blood smear and was confirmed on bone marrow by flowcytometry. Karyotyping revealed Trisomy 21.
Collapse
Affiliation(s)
- Aishwarya Raj
- />Department of Pathology, Gauhati Medical College and Hospital, Guwahati, Assam India
| | - Sewali Talukdar
- />Department of Clinical Haematology, Gauhati Medical College and Hospital, Guwahati, Assam India
| | - Smita Das
- />Department of Clinical Haematology, Gauhati Medical College and Hospital, Guwahati, Assam India
| | - Pabitra Kumar Gogoi
- />Department of Clinical Haematology, Gauhati Medical College and Hospital, Guwahati, Assam India
| | - Damodar Das
- />Department of Clinical Haematology, Gauhati Medical College and Hospital, Guwahati, Assam India
| | - Jina Bhattacharya
- />Department of Clinical Haematology, Gauhati Medical College and Hospital, Guwahati, Assam India
| |
Collapse
|
5
|
Burjonrappa SC. Management of Duodenal Atresia in the setting of Congenital Leukemia with Massive Hepatomegaly. J Neonatal Surg 2013; 2:32. [PMID: 26023452 PMCID: PMC4422272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/07/2013] [Indexed: 11/23/2022] Open
Abstract
Down's syndrome (DS) is associated with duodenal atresia (DA) in about 8-10% of cases. Transient Myeloproliferative Disorder (TMD)/Acute Myeloid Leukemia (AML) is also associated with the trisomy 21 mutation. The occurrence of the two conditions together complicates the diagnosis and surgical management of the DA. We discuss the technical aspects of management of the DA in this clinical setting.
Collapse
|
6
|
Reyes ZS, Bashir W, Pathare A. Transient Myeloproliferative Disorder and Down Syndrome: Is there a link? Sultan Qaboos Univ Med J 2013; 12:498-502. [PMID: 23275848 DOI: 10.12816/0003177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/03/2012] [Accepted: 06/27/2012] [Indexed: 11/27/2022] Open
Abstract
An extremely premature male neonate presented with an unusual multisystem dysfunction within the first 24 to 48 hours of life. The unfolding of clinical events and investigations revealed a transient myeloproliferative disorder (TMD). TMD was the main indication for karyotyping of this premature infant without clinical symptoms of Down syndrome. The awareness of TMD in a newborn warrants karyotype analysis to look for trisomy 21 and a close surveillance because of its potential progression to true leukaemia.
Collapse
|
7
|
Marwah N, Modi S, Gupta V, Gupta S, Singh G, Sen R. Transient leukaemia: leukaemia or leukaemoid? A diagnostic dilemma. Indian J Hematol Blood Transfus 2012; 28:47-9. [PMID: 23450144 PMCID: PMC3311962 DOI: 10.1007/s12288-011-0090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 06/13/2011] [Indexed: 11/28/2022] Open
Abstract
We report a case of a newborn male who had mongoloid slant and was hypotonic at birth. Routine investigations revealed leucocytosis (WBC > 70,000/cmm) with 50% blasts in peripheral blood film. Marrow examination confirmed the excess of blasts. Karyotyping revealed 47, XY + 21 chromosomes. Due to absence of clinical symptoms, the baby was kept on follow-up without treatment. Within 7 weeks, PBF and bone marrow findings returned to normal, and the child was diagnosed as having Transient leukaemia with Down syndrome.
Collapse
Affiliation(s)
- Nisha Marwah
- Department of Pathology, Pt. B.D. Sharma PGIMS, 2452, Sector-1, HUDA, Rohtak, 124001 India
| | - Shilpi Modi
- Department of Pathology, Pt. B.D. Sharma PGIMS, 2452, Sector-1, HUDA, Rohtak, 124001 India
| | - Veena Gupta
- Department of Pathology, Pt. B.D. Sharma PGIMS, 2452, Sector-1, HUDA, Rohtak, 124001 India
| | - Sumiti Gupta
- Department of Pathology, Pt. B.D. Sharma PGIMS, 2452, Sector-1, HUDA, Rohtak, 124001 India
| | - Gajender Singh
- Department of Pathology, Pt. B.D. Sharma PGIMS, 2452, Sector-1, HUDA, Rohtak, 124001 India
| | - Rajeev Sen
- Department of Pathology, Pt. B.D. Sharma PGIMS, 2452, Sector-1, HUDA, Rohtak, 124001 India
| |
Collapse
|
8
|
Manivannan P, Prasaad PR, Kar R, Basu D. Down syndrome with different hematological manifestations: a short series of 3 cases with review of literature. Indian J Hematol Blood Transfus 2012; 29:31-4. [PMID: 24426330 DOI: 10.1007/s12288-011-0134-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 12/01/2011] [Indexed: 11/26/2022] Open
Abstract
Children with Down syndrome (DS) present with a spectrum of hematolymphoid malignancies ranging from transient myeloproliferative disorder (TMD) which regress spontaneously to frank acute leukemia of both myeloid and lymphoid lineage. Here we present a series of three cases with different manifestation in DS. Three cases of DS presented with TMD, acute myeloid leukemia (AML-M2) and acute megakaryoblastic leukemia (AMKL), respectively. This case series displays the spectrum of hematological manifestations in children with DS. Although TMD and AMKL are strongly associated with DS, other AML subtypes can also be seen in such patients.
Collapse
Affiliation(s)
| | | | - Rakhee Kar
- Department of Pathology, JIPMER, Puducherry, 605 006 India
| | - Debdatta Basu
- Department of Pathology, JIPMER, Puducherry, 605 006 India
| |
Collapse
|
9
|
Gosavi AV, Murarkar PS, Lanjewar DN, Ravikar RV. Transient leukemia in down syndrome: report of two cases with review of literature. Indian J Hematol Blood Transfus 2011; 27:172-6. [PMID: 22942569 DOI: 10.1007/s12288-011-0079-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 05/23/2011] [Indexed: 11/24/2022] Open
Abstract
Transient leukemia (TL) also referred to as transient abnormal myelopoiesis (TAM) or transient myeloproliferative disorder (TMD) is a unique syndrome that frequently occurs in newborns with Down syndrome (DS). It manifests in the first few days of life and shows leukocytosis with blast cells in the blood and bone marrow. This leukemia resolves spontaneously within first few months of life in the majority of cases. In this report we describe two newborns with a karyotype of 47,XY,+21, presented with marked leukocytosis and many blast cells in the peripheral blood. In both the cases, the blasts disappeared and the total leukocyte count reverted to normal without any specific treatment.
Collapse
Affiliation(s)
- Alka V Gosavi
- Department of Pathology, Government Medical College, Miraj, India
| | | | | | | |
Collapse
|