BACKGROUND T-cell large granular lymphocytic leukemia(T-LGLL)is a rare type of aplastic anemia with diverse clinical manifestations.Concomitant diseases are often present at the first manifestation.We describe the tre...BACKGROUND T-cell large granular lymphocytic leukemia(T-LGLL)is a rare type of aplastic anemia with diverse clinical manifestations.Concomitant diseases are often present at the first manifestation.We describe the treatment of a patient with CD57-negativeγδT-LGLL with pure red cell aplasia(PRCA).CASE SUMMARY A 34-year-old woman with a 20-year history of anemia visited our hospital owing to severe dizziness and was admitted.Her condition was diagnosed as CD57-negativeγδT-LGLL with PRCA through bone marrow cytology,bone marrow pathology,bone marrow flow cytometry,bone marrow multiplex polymerase chain reaction combined with fluorescent fragment analysis,and other tests.Treatment with prednisone,methotrexate,and subcutaneous erythropoietin did not significantly change her hemoglobin level.After treatment with oral cyclophosphamide for 3 mo,her hemoglobin level increased to approximately 100 g/L.After 5 mo of treatment,the patient could perform activities of daily living independently.CONCLUSION The treatment of CD57-negativeγδT-LGLL with PRCA with cyclophosphamide helps to improve prognosis.展开更多
BACKGROUND The Coexistence of myeloid and lymphoid malignancies is rare.Myeloid leukemia occurs more frequently as a secondary event in patients receiving chemotherapy agents for lymphoid malignancies.Synchronous diag...BACKGROUND The Coexistence of myeloid and lymphoid malignancies is rare.Myeloid leukemia occurs more frequently as a secondary event in patients receiving chemotherapy agents for lymphoid malignancies.Synchronous diagnoses of diffuse large B-cell lymphoma(DLBCL),acute myeloid leukemia(AML),and untreated lymphoplasmacytic lymphoma/Waldenström macroglobulinemia(LPL/WM)in the same patient have not been reported.Here we report one such case.CASE SUMMARY An 89-year-old man had a chest wall mass histopathologically diagnosed as DLBCL.The bone marrow and peripheral blood contained two groups of cells.One group of cells fulfilled the criteria of AML,and the other revealed the features of small B lymphocytic proliferative disorder,which we considered LPL/WM.Multiple chromosomal or genetic changes were detected in bone marrow mononuclear cells,including ATM deletion,CCND1 amplification,mutations of MYD88(L265P)and TP53,WT1 overexpression,and fusion gene of BIRC2-ARAP1,as well as complex chromosomal abnormalities.The patient refused chemotherapy because of old age and died of pneumonia 1 mo after the final diagnosis.CONCLUSION The coexistence of DLBCL,AML,and untreated LPL/WM in the same patient is extremely rare,which probably results from multiple steps of genetic abnormalities.Asymptomatic LPL/WM might have occurred first,then myelodysplastic syndromerelated AML developed,and finally aggressive DLBCL arose.Therefore,medical staff should pay attention to this rare phenomenon to avoid misdiagnoses.展开更多
Hemophagocytic syndrome (HPS) usually presents as a complication of T/NK cell lymphoma. However, γδ-T large granular lymphocyte leukemia (LGL) associated HPS was rarely reported. Herein, we reported a case of γδ-T...Hemophagocytic syndrome (HPS) usually presents as a complication of T/NK cell lymphoma. However, γδ-T large granular lymphocyte leukemia (LGL) associated HPS was rarely reported. Herein, we reported a case of γδ-T LGL associated HPS. A previously healthy 21-year-old Chinese man was admitted with high fever, severe pancytopenia and liver dysfunction. He developed disseminated intravascular coaggulation (DIC), shock, gastrointestinal bleeding, acute renal failure as well as central nervous system involvement. Bone marrow aspiration showed infiltration of large granular lymphocytes and hemophagocytic histiocytes. Immunophenotyping analysis by four-color flow cytometry showed the leukemic cells with large side scatter (SSC), CD3+, CD2+, CD8+, CD5-, CD7 partly+, CD4-, CD56-, CD57-. Polymerase chain reaction (PCR) amplification of TCRβ and γ chain gene rearrangement confirmed TCRγδ T cell clone. Thus, a diagnosis of γδ-T LGL associated HPS was established. The patient worsened rapidly and died of multiple organ failure.展开更多
Variants in the solute carrier family 40 member 1(SLC40A1)gene are the molecular basis of ferroportin disease,which is an autosomal dominant hereditary hemochromatosis.Here,we present a patient with pure red cell apla...Variants in the solute carrier family 40 member 1(SLC40A1)gene are the molecular basis of ferroportin disease,which is an autosomal dominant hereditary hemochromatosis.Here,we present a patient with pure red cell aplasia(PRCA)and large granular lymphocytic leukemia(LGLL)associated with an extremely high levels of serum ferritin and iron overload syndrome.Whole exon sequencing revealed a novel heterozygous variant in SLC40A1(p.T419I),which was found in his daughter as well.A series of functional studies in vitro of the T419I variant in ferroportin were conducted and the results revealed a reduced capacity of iron export from cells without changes in protein localization and its sensitivity to hepcidin.Intracellular iron storage in mutated cells was significantly higher than that of wild-type.These findings suggest that the novel variant p.T419I can cause the classical form of ferroportin disease and an elevated intracellular iron level indicates a potential novel pathogenic mechanism underlying PRCA and LGLL.展开更多
本文回顾性分析2021年3月山东大学附属威海市立医院收治的1例CD4^(-)CD8^(-)TCRγδ^(+)T细胞大颗粒淋巴细胞白血病(T-cell large granular lymphocyte leukemia,T-LGLL)合并纯红细胞再生障碍性贫血(Pure red cell aplasia,PRCA)患者的...本文回顾性分析2021年3月山东大学附属威海市立医院收治的1例CD4^(-)CD8^(-)TCRγδ^(+)T细胞大颗粒淋巴细胞白血病(T-cell large granular lymphocyte leukemia,T-LGLL)合并纯红细胞再生障碍性贫血(Pure red cell aplasia,PRCA)患者的临床资料,并复习相关文献,以提高对CD4^(-)CD8^(-)TCRγδ^(+)T-LGLL合并PRCA的认知,从而减少临床中的误诊及漏诊。展开更多
大颗粒淋巴细胞白血病(large granular lymphocytic leukemia,LGLL)是一类少见的淋巴增殖性疾病,是血液和骨髓中细胞毒性T细胞和NK细胞的克隆性扩增,常常和自身免疫性疾病有关。根据2008年WHO淋巴与造血组织肿瘤分类,LGLL分为T细胞大颗...大颗粒淋巴细胞白血病(large granular lymphocytic leukemia,LGLL)是一类少见的淋巴增殖性疾病,是血液和骨髓中细胞毒性T细胞和NK细胞的克隆性扩增,常常和自身免疫性疾病有关。根据2008年WHO淋巴与造血组织肿瘤分类,LGLL分为T细胞大颗粒淋巴细胞白血病(Tell large granular lymphocytic leukemia T-,GLL)、慢性NK细胞增殖性疾病(chronic lymphoproliferative disease of NK cells,CLPD-VK)和侵袭性NK细胞白血病(aggressive NK cell leukemia,ANKL)。由于对这种疾病缺乏认识,一些患者可能被误诊或者漏诊。目前,LGLL的发病机制尚不清楚,并且治疗效果并不令人满意。因此发现这种疾病的预后标记和治疗靶点十分必要。JAK/STAT通路的持续激活与LGLL的发展密切相关,近年来,在LGLL中发现STAT3基因的突变,突变位于二聚化界面上的SH2区域,介导STAT3的激活。STAT3是第1个针对LGLL高度特异的分子标记,在其他肿瘤中几乎检测不到STAT3的突变。因此,STAT3突变能被用作为LGLL诊断的分子标记,并为LGLL提供一个新的治疗靶点。展开更多
基金Supported by Xiamen Medical and Health Guidance Project,No.3502Z20199137Fujian Medical and Health Training Project for Young and Middle-aged Backbone Talents,No.2020GGB068Educational and Scientific Research Program for Young and Middle-Aged Teachers of Fujian Province,No.JAT190838.
文摘BACKGROUND T-cell large granular lymphocytic leukemia(T-LGLL)is a rare type of aplastic anemia with diverse clinical manifestations.Concomitant diseases are often present at the first manifestation.We describe the treatment of a patient with CD57-negativeγδT-LGLL with pure red cell aplasia(PRCA).CASE SUMMARY A 34-year-old woman with a 20-year history of anemia visited our hospital owing to severe dizziness and was admitted.Her condition was diagnosed as CD57-negativeγδT-LGLL with PRCA through bone marrow cytology,bone marrow pathology,bone marrow flow cytometry,bone marrow multiplex polymerase chain reaction combined with fluorescent fragment analysis,and other tests.Treatment with prednisone,methotrexate,and subcutaneous erythropoietin did not significantly change her hemoglobin level.After treatment with oral cyclophosphamide for 3 mo,her hemoglobin level increased to approximately 100 g/L.After 5 mo of treatment,the patient could perform activities of daily living independently.CONCLUSION The treatment of CD57-negativeγδT-LGLL with PRCA with cyclophosphamide helps to improve prognosis.
基金Supported by the National Natural Science Foundation of China,No.81700130Nanjing Medical University Science and Technology Development Fund.
文摘BACKGROUND The Coexistence of myeloid and lymphoid malignancies is rare.Myeloid leukemia occurs more frequently as a secondary event in patients receiving chemotherapy agents for lymphoid malignancies.Synchronous diagnoses of diffuse large B-cell lymphoma(DLBCL),acute myeloid leukemia(AML),and untreated lymphoplasmacytic lymphoma/Waldenström macroglobulinemia(LPL/WM)in the same patient have not been reported.Here we report one such case.CASE SUMMARY An 89-year-old man had a chest wall mass histopathologically diagnosed as DLBCL.The bone marrow and peripheral blood contained two groups of cells.One group of cells fulfilled the criteria of AML,and the other revealed the features of small B lymphocytic proliferative disorder,which we considered LPL/WM.Multiple chromosomal or genetic changes were detected in bone marrow mononuclear cells,including ATM deletion,CCND1 amplification,mutations of MYD88(L265P)and TP53,WT1 overexpression,and fusion gene of BIRC2-ARAP1,as well as complex chromosomal abnormalities.The patient refused chemotherapy because of old age and died of pneumonia 1 mo after the final diagnosis.CONCLUSION The coexistence of DLBCL,AML,and untreated LPL/WM in the same patient is extremely rare,which probably results from multiple steps of genetic abnormalities.Asymptomatic LPL/WM might have occurred first,then myelodysplastic syndromerelated AML developed,and finally aggressive DLBCL arose.Therefore,medical staff should pay attention to this rare phenomenon to avoid misdiagnoses.
文摘Hemophagocytic syndrome (HPS) usually presents as a complication of T/NK cell lymphoma. However, γδ-T large granular lymphocyte leukemia (LGL) associated HPS was rarely reported. Herein, we reported a case of γδ-T LGL associated HPS. A previously healthy 21-year-old Chinese man was admitted with high fever, severe pancytopenia and liver dysfunction. He developed disseminated intravascular coaggulation (DIC), shock, gastrointestinal bleeding, acute renal failure as well as central nervous system involvement. Bone marrow aspiration showed infiltration of large granular lymphocytes and hemophagocytic histiocytes. Immunophenotyping analysis by four-color flow cytometry showed the leukemic cells with large side scatter (SSC), CD3+, CD2+, CD8+, CD5-, CD7 partly+, CD4-, CD56-, CD57-. Polymerase chain reaction (PCR) amplification of TCRβ and γ chain gene rearrangement confirmed TCRγδ T cell clone. Thus, a diagnosis of γδ-T LGL associated HPS was established. The patient worsened rapidly and died of multiple organ failure.
基金was supported by grants from the National Natural Science Foundation of China under grant numbers 81770119&81700120。
文摘Variants in the solute carrier family 40 member 1(SLC40A1)gene are the molecular basis of ferroportin disease,which is an autosomal dominant hereditary hemochromatosis.Here,we present a patient with pure red cell aplasia(PRCA)and large granular lymphocytic leukemia(LGLL)associated with an extremely high levels of serum ferritin and iron overload syndrome.Whole exon sequencing revealed a novel heterozygous variant in SLC40A1(p.T419I),which was found in his daughter as well.A series of functional studies in vitro of the T419I variant in ferroportin were conducted and the results revealed a reduced capacity of iron export from cells without changes in protein localization and its sensitivity to hepcidin.Intracellular iron storage in mutated cells was significantly higher than that of wild-type.These findings suggest that the novel variant p.T419I can cause the classical form of ferroportin disease and an elevated intracellular iron level indicates a potential novel pathogenic mechanism underlying PRCA and LGLL.
文摘本文回顾性分析2021年3月山东大学附属威海市立医院收治的1例CD4^(-)CD8^(-)TCRγδ^(+)T细胞大颗粒淋巴细胞白血病(T-cell large granular lymphocyte leukemia,T-LGLL)合并纯红细胞再生障碍性贫血(Pure red cell aplasia,PRCA)患者的临床资料,并复习相关文献,以提高对CD4^(-)CD8^(-)TCRγδ^(+)T-LGLL合并PRCA的认知,从而减少临床中的误诊及漏诊。
文摘大颗粒淋巴细胞白血病(large granular lymphocytic leukemia,LGLL)是一类少见的淋巴增殖性疾病,是血液和骨髓中细胞毒性T细胞和NK细胞的克隆性扩增,常常和自身免疫性疾病有关。根据2008年WHO淋巴与造血组织肿瘤分类,LGLL分为T细胞大颗粒淋巴细胞白血病(Tell large granular lymphocytic leukemia T-,GLL)、慢性NK细胞增殖性疾病(chronic lymphoproliferative disease of NK cells,CLPD-VK)和侵袭性NK细胞白血病(aggressive NK cell leukemia,ANKL)。由于对这种疾病缺乏认识,一些患者可能被误诊或者漏诊。目前,LGLL的发病机制尚不清楚,并且治疗效果并不令人满意。因此发现这种疾病的预后标记和治疗靶点十分必要。JAK/STAT通路的持续激活与LGLL的发展密切相关,近年来,在LGLL中发现STAT3基因的突变,突变位于二聚化界面上的SH2区域,介导STAT3的激活。STAT3是第1个针对LGLL高度特异的分子标记,在其他肿瘤中几乎检测不到STAT3的突变。因此,STAT3突变能被用作为LGLL诊断的分子标记,并为LGLL提供一个新的治疗靶点。
