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Zheng J, Liu H, Chen Y, Xie W, Wang K, Chen L, Gao K. Lymphoproliferative disorders of natural killer cells: report of two cases and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1755-1759. [PMID: 32782701 PMCID: PMC7414496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
Lymphoproliferative disorders of natural killer cells (LPD-NK) are rare lymphoproliferative diseases involving NK cells. Here, we present two cases of LPD-NK. The first case is a 63-year-old man who presented with high fever, cytopenia, and a history of myelodsyplastic syndrome. He was finally diagnosed with aggressive NK cell leukemia and died due to progression of the disease within 15 days of diagnosis. The second case is a 70-year-old man with granulocytopenia who did not have clinical manifestations; he was diagnosed with chronic lymphoproliferative disorder of NK cells and a watch and wait approach was adopted until six-month follow up. This article describes the clinical features, pathogenesis, diagnosis, treatments, and prognosis of LPD-NK through a literature review of case reports.
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Affiliation(s)
- Jing Zheng
- Department of Hematology, The First People’s Hospital of Yichang, China Three Gorges UniversityYichang, Hubei, China
| | - Hongjiang Liu
- Department of Rheumatology and Clinical Immunology, The First People’s Hospital of Yichang, China Three Gorges UniversityYichang, Hubei, China
| | - Yonghong Chen
- Department of Hematology, The First People’s Hospital of Yichang, China Three Gorges UniversityYichang, Hubei, China
| | - Wei Xie
- Department of Hematology, The First People’s Hospital of Yichang, China Three Gorges UniversityYichang, Hubei, China
| | - Kai Wang
- Department of Rheumatology and Clinical Immunology, The First People’s Hospital of Yichang, China Three Gorges UniversityYichang, Hubei, China
| | - Lu Chen
- Department of Medical Record Management Division, The First People’s Hospital of Yichang, China Three Gorges UniversityYichang, Hubei, China
| | - Kaibo Gao
- Department of Hematology, The First People’s Hospital of Yichang, China Three Gorges UniversityYichang, Hubei, China
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Jin C, Bandovic J, Brody J, Hsu P, Sheikh-Fayyaz S, Zhang X. Aggressive natural killer cell leukemia mimicking interstitial lung diseases with the activation of the mitogen-activated protein kinase pathway. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:5502-5508. [PMID: 31949637 PMCID: PMC6963020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/25/2018] [Indexed: 06/10/2023]
Abstract
Aggressive natural killer (NK) cell leukemia (ANKL) is a rare form of leukemia with an aggressive clinical course. It commonly involves the peripheral blood, bone marrow, liver, and spleen but rarely involves the lungs. We report a 36 year-old woman who presented with pulmonary lesions we suspected to be interstitial lung disease on an imaging study. A lung biopsy showed extensive lymphoid infiltrate growing along pre-existing alveolar septa without destroying the alveolar spaces. Further workup revealed hepatomegaly, borderline splenomegaly, and multiple lymphadenopathies. Her laboratory tests showed leukocytosis, anemia, thrombocytopenia, abnormal liver enzymes, and elevated lactate dehydrogenase. A bone marrow (BM) aspirate smear revealed many intermediate to large lymphocytes with dispersed chromatin, basophilic cytoplasm, and some azurophilic granules. A BM biopsy showed hypercellularity with interstitial lymphoid infiltrate in a background of trilineage hematopoiesis and histiocytosis with hemophagocytosis. Immunohistochemical studies performed on both the lung and BM biopsies showed the neoplastic cells to be positive for CD2, CD3, CD7, CD56, granzyme B, phosphor-MAPK (pMAPK), EBER (Epstein-Barr Virus-encoded small RNA) by in situ hybridization; they were negative for CD4, CD5, CD8, CD30, LMP1, and phospho-STAT3 (pSTAT3). A flow cytometry analysis of the BM aspirate identified a population of atypical lymphocytes with the NK cell phenotype. Molecular studies were negative for T-cell receptor gene rearrangements, and the neoplastic cells displayed a complex karyotype. The patient responded initially to chemotherapy but died of multiorgan failure two months after the diagnosis. We present a case of ANKL mimicking interstitial lung disease with the activation of MAPK pathway.
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Affiliation(s)
- Cao Jin
- />Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellLake Success, NY 11042, USA
| | - Jela Bandovic
- />Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellLake Success, NY 11042, USA
- Current address: Department of Pathology, University HospitalLevel 2, Room 749, Stony Brook Medicine, Stony Brook, NY 11794-7025, USA
| | - Judith Brody
- />Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellLake Success, NY 11042, USA
| | - Peihong Hsu
- />Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellLake Success, NY 11042, USA
| | - Silvat Sheikh-Fayyaz
- />Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellLake Success, NY 11042, USA
| | - Xinmin Zhang
- />Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellLake Success, NY 11042, USA
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Gao J, Behdad A, Ji P, Wolniak KL, Frankfurt O, Chen YH. EBV-negative aggressive NK-cell leukemia/lymphoma: a clinical and pathological study from a single institution. Mod Pathol 2017; 30:1100-1115. [PMID: 28548121 DOI: 10.1038/modpathol.2017.37] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 01/12/2023]
Abstract
Aggressive natural killer (NK)-cell leukemia/lymphoma is a systemic NK-cell neoplasm that preferentially affects Asians with a fulminant clinical course and is almost always associated with Epstein-Barr virus (EBV). The data on EBV-negative aggressive NK-cell leukemia/lymphoma are limited. Here we report a series of three patients (two Caucasians, one African-American) with EBV-negative aggressive NK-cell leukemia/lymphoma from a single institution, including a case diagnosed on post-mortem examination. Similar to EBV-positive aggressive NK-cell leukemia/lymphoma, our patients presented with constitutional symptoms and hepatosplenomegaly, and followed a highly aggressive clinical course. The disease involved peripheral blood, bone marrow, liver, spleen, and lymph node, and the neoplastic cells were pleomorphic with prominent azurophilic granules and demonstrated an atypical NK-cell phenotype. Lack of blood lymphocytosis (3 of 3), bone marrow interstitial infiltration (2 of 3), EBER negativity (3 of 3), and atypical phenotype including CD3 negativity by immunohistochemistry make an early recognition of the disease difficult. Ancillary studies revealed a complex karyotype (1 of 2), overexpression (3 of 3), and amplification (1 of 1) of c-MYC. The polycomb repressive complex 2 pathway-associated proteins EZH2 and H3K27me3 and immune checkpoint protein PD-L1 were overexpressed in three of three and two of three cases, respectively. Our findings indicate that the EBV-negative aggressive NK-cell leukemia/lymphoma shares similar clinicopathological features to the EBV-positive counterpart except for the high prevalence of Asian seen in EBV-positive cases. Overexpression of polycomb repressive complex 2 pathway-associated proteins and PD-L1 suggest potential therapeutic targets for this aggressive disease. Next-generation sequencing on two of three cases identified multiple genetic alterations but were negative for JAK-STAT pathway-associated gene mutations previously reported in EBV-positive NK/T-cell lymphoma, suggesting alternative molecular pathogenic mechanisms for EBV-negative aggressive NK-cell leukemia/lymphoma.
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Affiliation(s)
- Juehua Gao
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amir Behdad
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Peng Ji
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristy L Wolniak
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Olga Frankfurt
- Division of Hematology-Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yi-Hua Chen
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Olde Bekkink M, Ahmed-Ousenkova YM, Netea MG, van der Velden WJ, Berden JH. Coexistence of systemic lupus erythematosus, tuberous sclerosis and aggressive natural killer-cell leukaemia: coincidence or correlated? Lupus 2016; 25:766-71. [PMID: 26946293 DOI: 10.1177/0961203316636466] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
Abstract
Among patients with systemic lupus erythematosus (SLE) there is an increased risk of haematological malignancies, especially non-Hodgkin lymphoma. However, the association of SLE with aggressive CD3 negative natural killer (NK)-cell leukaemia has not been reported so far. We present a case of a 39-year-old woman with SLE, aggressive NK-cell leukaemia and tuberous sclerosis complex. The prior probability of developing the combination of these three rare diseases by coincidence is extremely low (<10(-13)). Possible underlying immunological, genetic and toxic/environmental pathways are discussed.
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Affiliation(s)
- M Olde Bekkink
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Y M Ahmed-Ousenkova
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M G Netea
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W J van der Velden
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J H Berden
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Tees MT, Whitehurst MT, Sokol L. Treating rare lymphoproliferative malignancies: a focus on indolent large granular lymphocytic leukemia. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Large granular lymphocyte leukemia is a heterogeneous group of lymphoproliferative disorders that arises from mature T cells or NK cells. These disorders are relatively uncommon and usually present with cytopenias and/or autoimmune disorders. As patients often do not have symptoms warranting therapy upfront, surveillance is often employed. Common frontline therapies include cyclosphosphamide, methotrexate or cyclosporine A, however, no controlled trials or retrospective analyses have demonstrated one superior therapeutic strategy. Mechanisms of pathogenesis and survival have been identified that include abnormalities in the cell surface receptors halting apoptotic signals, dysregulation of prosurvival and apoptotic signaling pathways, and somatic mutations of the STAT3 and STAT5b genes, among others. Investigating novel therapies that target pathways shared by other neoplastic processes, as well as the identification of new agents directed toward the aberrant cellular mechanisms of large granular lymphocyte leukemia, are fundamental to moving from empiric chemotherapy to targeted therapies in the future.
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Affiliation(s)
- Michael T Tees
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Matthew T Whitehurst
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Zhang Q, Jing W, Ouyang J, Zeng H, George SK, Liu Z. Six cases of aggressive natural killer-cell leukemia in a Chinese population. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:3423-3431. [PMID: 25031771 PMCID: PMC4097262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/27/2014] [Indexed: 06/03/2023]
Abstract
Aggressive natural killer cell leukemia (ANKL) is a rare hematological malignancy that is particularly common among the Asian population. In the current study, we retrospectively evaluated six Chinese ANKL patients, including five males and one female, with a median age of 42 years (range 22 to 50 years). A number of unusual pathogenic manifestations were found in these ANKL patients, such as isolated extraocular muscle involvement, and hemophagocytic syndrome (HPS) with acute renal failure and multiple cavity effusion. Four of the patients died between two and six months after the diagnosis; however, there were two ANKL cases whose clinical behavior differed from the typical clinical course. One survived for over 30 months after splenectomy and chemotherapy treatment, and another ANKL case derived from chronic lymphoproliferative disorders of NK-cells (CLPD-NK) was treated with allogeneic bone marrow transplant (allo-BMT) and survived over 18 months. In conclusion, four cases experienced an aggressive clinical course whereas two demonstrated an indolent manifestation of their disease. New therapeutic regimens including allo-BMT should be optimized in order to improve outcomes of this disease.
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Affiliation(s)
- Qiguo Zhang
- Department of Hematology, Nanjing University Drum Tower HospitalNanjing 210008, Jiangsu, China
| | - Wang Jing
- Department of Hematology, Nanjing University Drum Tower HospitalNanjing 210008, Jiangsu, China
| | - Jian Ouyang
- Department of Hematology, Nanjing University Drum Tower HospitalNanjing 210008, Jiangsu, China
| | - Hui Zeng
- Department of Hematology, Nanjing University Drum Tower HospitalNanjing 210008, Jiangsu, China
| | - Suraj K George
- Department of Hematopathology, University of Texas MD Anderson Cancer CenterHouston, Texas 77054, USA
| | - Zhiqiang Liu
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer CenterHouston, Texas 77054, USA
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