T淋巴母细胞白血病并发纯红白血病病例分析

doi:10.3969/j.issn.1673-8640.2024.10.015

摘要/Abstract

摘要：

分析1例T淋巴母细胞白血病（T-ALL）多程化疗后并发纯红白血病（PEL）病例的诊断过程。该病例造血干细胞移植前评估发现骨髓红系异常增生（占74.20%），其中原始红细胞占33.40%，淋巴细胞占3.00%，原始、幼稚淋巴细胞占0.40%。流式细胞分析报告62.25%原始/早幼红细胞和0.05%异常幼稚T淋巴细胞。骨髓病理示骨髓增生明显活跃，以红系增生为主，各阶段均可见，红系原始细胞>30.00%。移植后再次复发时胸腔积液样本中同时检出原始、幼稚红细胞和原始、幼稚淋巴细胞。根据各项实验室检测结果和临床特征，考虑T-ALL并发PEL诊断。

中图分类号:

R733.7

付兆强, 张炳尧, 苏梦雅, 杨倩, 张旭曦, 秦尤文. T淋巴母细胞白血病并发纯红白血病病例分析[J]. 检验医学, 2024, 39(10): 1015-1020.

图/表 4

图1 2020年10月21日骨髓涂片形态（瑞-姬染色，×1 000）

图2 2021年6月30日骨髓涂片形态（瑞-姬染色和特殊化学染色，×1 000）注：（a）（b）（c）瑞-姬染色，可见大量原始、幼稚红细胞，罕见原始淋巴细胞（绿色箭头）；（d）POX原始、幼稚红细胞阴性；（e）DCE原始、幼稚红细胞偶见阳性（红色箭头）；（f）PAS原始、幼稚红细胞罕见阳性（红色箭头）；（g）ANAE原始、幼稚红细胞呈局灶性细块状阳性；（h）ANAE+NAF阴性。

图3 2021年11月11日胸腔积液甩片（×1 000）注：（a）瑞-姬染色；（b）PAS染色，部分原始、幼稚红细胞阳性；可见原始、幼稚红细胞（红色箭头）和原始、幼稚淋巴细胞（绿色箭头）。

图4 2021年7月3日骨髓病理切片（×400）注：（a）苏木精-伊红染色；（b）CD117；（c）CD71；（d）CD235a；（e）E-cad；（f）PAS染色；（g）CD34；（h）TP53 。

参考文献 19

[1]	International Agency for Research on Cancer. WHO classification of tumours of haematopoietic and lymphoid tissues[EB/OL].(2017-09-07)[2023-07-30]. https://www.iarc.who.int/news-events/who-classification-of-tumours-of-haematopoietic-and-lymphoid-tissues-2/.
[2]	ARBER D A, ORAZI A, HASSERJIAN R P, et al. International consensus classification of myeloid neoplasms and acute leukemias:integrating morphologic,clinical,and genomic data[J]. Blood, 2022, 140(11):1200-1228.
[3]	KHOURY J D, SOLARY E, ABLA O, et al. The 5th edition of the World Health Organization classification of haematolymphoidtumours:myeloid and histiocytic/dendritic neoplasms[J]. Leukemia, 2022, 36(7):1703-1719.
[4]	LIU W, HASSERJIAN R P, HU Y, et al. Pure erythroid leukemia:a reassessment of the entity using the 2008 World Health Organization classification[J]. Mod Pathol, 2011, 24(3):375-383.
[5]	LI H, HASSERJIAN R P, KROFT S H, et al. Pure erythroid leukemia and erythroblastic sarcoma evolving from chronic myeloid neoplasms[J]. Am J Clin Pathol, 2016, 145(4):538-551. DOI PMID
[6]	WANG S A, HASSERJIAN R P. Acute erythroleukemias,acute megakaryoblastic leukemias,and reactive mimics:a guide to a number of perplexing entities[J]. Am J Clin Pathol, 2015, 144(1):44-60.
[7]	SATO S, KOBAYASHI M, SUZAKI K, et al. Challenging diagnosis of pure erythroid leukemia:a case report and literature review[J]. Hematol Rep, 2022, 14(1):38-44.
[8]	WEINBERG O K, ARBER D A. Erythroleukemia:an update[J]. Curr Oncol Rep, 2021, 23(6):69.
[9]	FANG H, WANG S A, YOU M J, et al. Flow cytometry immunophenotypic features of pure erythroid leukemia and the distinction from reactive erythroid precursors[J]. Cytometry B Clin Cytom, 2022, 102(6):440-447.
[10]	REICHARD K K, TEFFERI A, ABDELMAGID M, et al. Pure(acute)erythroid leukemia:morphology,immunophenotype,cytogenetics,mutations,treatment details,and survival data among 41 Mayo clinic cases[J]. Blood Cancer J, 2022, 12(11):147.
[11]	WANG W, WANG S A, MEDEIROS L J, et al. Pure erythroid leukemia[J]. Am J Hematol, 2017, 92(3):292-296. DOI PMID
[12]	FANG H, WANG S A, KHOURY J D, et al. Pure erythroid leukemia is characterized by biallelic TP53 inactivation and abnormal p53 expression patterns in de novo and secondary cases[J]. Haematologica, 2022, 107(9):2232-2237.
[13]	REINIG E F, GREIPP P T, CHIU A, et al. De novo pure erythroid leukemia:refining the clinicopathologic and cytogenetic characteristics of a rare entity[J]. Mod Pathol, 2018, 31(5):705-717.
[14]	MONTALBAN-BRAVO G, BENTON C B, WANG S A, et al. More than 1 TP53 abnormality is a dominant characteristic of pure erythroid leukemia[J]. Blood, 2017, 129(18):2584-2587.
[15]	ACOBS J W, RAMASWAMY R, STATES V, et al. Chronic myeloid leukemia with pure erythroid leukemia blast crisis[J]. Leuk Lymphoma, 2022, 63(1):212-216.
[16]	LIU L, DUDHEKER N, SUMARRIVA LEZAMA L M, et al. Transformation of polycythemia vera to pure erythroid leukemia[J]. Cureus, 2021, 13(7):e16168.
[17]	SADRZADEH H, HASSERJIAN R, FATHI A T. Pure erythroid leukemia evolving from a therapy-related myelodysplastic syndrome secondary to treatment for chronic lymphocytic leukemia[J]. Am J Hematol, 2013, 88(3):240-241. DOI PMID
[18]	XU M, FINN L S, TSUCHIYA K D, et al. Pure erythroid leukemia following precursor B-cell lymphoblastic leukemia[J]. Pediatr Dev Pathol, 2012, 15(1):76-78.
[19]	JI J, LI Y, FAN L, et al. Pure erythroid leukemia subsequent to acute myelomonocytic leukemia:a case report[J]. Medicine(Baltimore), 2021, 100(15):e25528.