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Vaidya P, Wang HY, Don MD, Hinds BR, Mangan JK. IDH2-mutated near ETP-ALL with aggressive leukemia cutis and brisk response to venetoclax and decitabine. Leuk Res Rep 2023; 21:100408. [PMID: 38269085 PMCID: PMC10805932 DOI: 10.1016/j.lrr.2023.100408] [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: 05/24/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024] Open
Abstract
Near early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a rare hematologic malignancy, for which second line therapeutic options are limited. T-cell leukemias are also rarely associated with leukemia cutis, which is more often seen in leukemias of myeloid origin. We present the case of an adult male diagnosed with near ETP-ALL, with IDH2 and DNMT3A mutations, suggestive of a myeloid origin, and leukemia cutis. After the patient progressed on hyper-CVAD and nelarabine, we treated him with the BCL-2 inhibitor venetoclax and the hypomethylating agent decitabine. The regimen induced a rapid bone marrow response and resolution of the leukemia cutis.
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Affiliation(s)
- Poorva Vaidya
- Department of Internal Medicine, Division of Hematology-Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Huan-You Wang
- Department of Pathology, University of California, San Diego, La Jolla, CA, United States
| | - Michelle D. Don
- Department of Pathology, University of California, San Diego, La Jolla, CA, United States
| | - Brian R. Hinds
- Department of Dermatology, University of California, San Diego, La Jolla, CA, United States
| | - James K. Mangan
- Department of Internal Medicine, Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
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Don MD, Lim W, Lo A, Cox B, Huang Q, Kitahara S, Lopategui J, Alkan S. Improved Recognition of Hematogones From Precursor B-Lymphoblastic Leukemia by a Single Tube Flow Cytometric Analysis. Am J Clin Pathol 2020; 153:790-798. [PMID: 32068791 DOI: 10.1093/ajcp/aqaa007] [Citation(s) in RCA: 2] [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] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To improve diagnostic accuracy in differentiating hematogones from leukemic blasts in cases of precursor B-lymphoblastic leukemia/lymphoma (B-ALL), particularly those that are posttreatment or after bone marrow transplant, and to provide an algorithmic approach to this diagnostic challenge. METHODS A seven-color antibody panel including CD10, CD19, CD45, CD38, CD34, CD58, and CD81 was generated to assess the feasibility of a single tube panel and provide an algorithmic approach to distinguish hematogones from B-ALL. Fifty-three cases were analyzed, and results were correlated with histology and ancillary studies. RESULTS There was a significant difference in mean fluorescent intensity (MFI) for CD81 and CD58 when comparing hematogones and B-ALL populations (P < .001). B-ALL cases had a mean (SD) MFI of 24.6 (27.5; range, 2-125) for CD81 and 135.6 (72.6; range, 48-328) for CD58. Hematogones cases had a mean (SD) MFI of 70.2 (19.2; range, 42-123) for CD81 and 38.8 (9.4; range, 23-58) for CD58. CONCLUSIONS The flow cytometry panel with the above markers and utilization of the proposed algorithmic approach provide differentiation of hematogones from B-ALL. This includes rare cases of hematogones and B-ALL overlap where additional ancillary studies are necessary.
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Affiliation(s)
- Michelle D Don
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Washington Lim
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Amanda Lo
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brian Cox
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Qin Huang
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sumire Kitahara
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jean Lopategui
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Serhan Alkan
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
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Sirohi D, Vaske C, Sanborn Z, Smith SC, Don MD, Lindsey KG, Federman S, Vankalakunti M, Koo J, Bose S, Peralta-Venturina MD, Ziffle JV, Grenert JP, Miller S, Chiu C, Amin MB, Simko JP, Stohr BA, Luthringer DJ. Polyoma virus-associated carcinomas of the urologic tract: a clinicopathologic and molecular study. Mod Pathol 2018; 31:1429-1441. [PMID: 29765141 DOI: 10.1038/s41379-018-0065-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 12/11/2022]
Abstract
In recent years, there has been increased interest in carcinomas of the urologic tract, that demonstrate association with the polyoma virus BK arising in immunosuppressed individuals, though the nature of this association is uncertain. To begin to understand this phenomenon, we reviewed the clinical, morphological, and immunohistochemical features of 11 carcinomas of the urologic tract, mainly urothelial (N = 9) and collecting duct carcinomas (N = 2), occurring during immunosuppression, and expressing polyoma virus T-antigen by immunohistochemistry. These were compared to a control group of carcinomas (N = 8), also arising during immunosuppression, but without T-antigen expression. A subset of both groups were also studied by hybrid capture-based DNA sequencing, probing not only for 479 cancer-related human genes, but also for polyoma and other viral sequences. Polyoma T-antigen-expressing tumors arose in 7 males and 4 females, at a median age of 66, and were aggressive, high-grade tumors with more than 1 variant morphologic pattern identified in 81% of cases, and a majority (73%) presenting at high stage category (>pT3). Diffuse polyoma T-antigen staining was seen in 91% of cases, with co-localization of aberrant p53 staining in 89%. Sequencing detected a lower number of deleterious mutations among T-antigen-expressing cases (average 1.62; 1/8 with TP53 mutation) compared to control cases (average 3.5, 2/4 with TP53 mutation). Only BK virus was detected with clonal integration and breakpoints randomly distributed across the human and viral genomes in 5/5 of the polyoma T-antigen-expressing carcinomas, and in none of the controls (0/4). In summary, these findings identify aggressive clinicopathologic features of polyoma T-antigen-expressing carcinomas, document BK as the strain involved, and associate BK viral integration with T-antigen expression and p53 aberrancy. While the apparent randomness of viral insertion sites is functionally unclear, the differing rates of mutations between T-antigen-expressing and control cases is intriguing.
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Affiliation(s)
- Deepika Sirohi
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA.
| | | | | | - Steven C Smith
- Departments of Pathology and Urology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle D Don
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Scot Federman
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Mahesha Vankalakunti
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jamie Koo
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shikha Bose
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Jessica van Ziffle
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - James P Grenert
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Steve Miller
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Charles Chiu
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis, TN, USA
| | - Jeffry P Simko
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Bradley A Stohr
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Daniel J Luthringer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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