1例急性粒单核细胞白血病M4C的MICM分型  

MICM classification for a case of acute myelomonocytic leukemia M4C

作　　者：侯莉萍 彭永平 苏小丽 冯苗娟 常子维 高山 于书春 田志强 于岩 辛晓丽 崔文静 赵亚萍 高广勋 朱华锋 HOU Liping;PENG Yongping;SU Xiaoli;FENG Miaojuan;CHANG Ziwei;GAO Shan;YU Shuchun;TIAN Zhiqiang;YU Yan;XIN Xiaoli;CUI Wenjing;ZHAO Yaping;GAO Guangxun;ZHU Huafeng(Department of Hematology, Xijing Hospital, Air Force Military Medical University, Xi′an, 710032, Shaanxi;Department of Blood Transfusion, Xi′an Aerospace General Hospital, Xi′an 710100, Shaanxi, China)

机构地区：[1]空军军医大学西京医院血液科,西安710032 [2]西安航天总医院输血科,西安710100

出　　处：《临床检验杂志》2019年第6期467-471,共5页Chinese Journal of Clinical Laboratory Science

摘　　要：目的报道1例急性粒单核细胞白血病M4C的MICM分型,以提高对M4C的认识。方法回顾性分析我院收治的1例M4C的病历资料,并对其进行骨髓细胞形态学、细胞化学染色、骨髓活检、免疫表型、染色体核型、融合基因、二代测序等检查分析。结果患者骨髓细胞形态示:骨髓增生明显活跃,粒单核细胞占85.6%。细胞化学染色示:过氧化物酶(POX)染色部分弱阳性;特异性酯酶(AS-DCE)染色部分阳性;非特异性酯酶(α-NBE)染色部分阳性,且被氟化钠抑制;非特异性酯酶(AS-DAE)染色部分阳性,且部分被氟化钠抑制。骨髓活检示:骨髓增生极活跃,幼稚细胞弥漫性增生。免疫表型结果示:异常细胞群表达CD11B、CD64、CD56、cMPO、CD33、CD41、CD61、CD38和CD58,不表达CD13、CD34、CD117、CD7、CD123、HLA-DR、CD10、CD19、CD20、CD2、CD14、CD235、CD15、CD303、CD304、CD25、cCD79a、cCD3、cCD22、CD1a和TDT。染色体核型分析显示见克隆性异常t(9;11)(p22;q23),+mar。白血病43种融合基因筛查检出MLLT3-KMT2A融合基因阳性。二代测序检出NRAS、TET2基因突变阳性。诊断为AML(急性粒单核细胞白血病)M4C伴t(9;11)(p22;q23);MLLT3-KMT2A。结论 M4C既具有粒细胞系又具有单核细胞系的特征,细胞形态学表现复杂,其诊断必需结合MICM分型综合判断。Objective To describe the MICM(morphology, immunology, cytogenetics and molecular biology) characteristics of a case of acute myelomonocytic leukemia M4 C. Methods The medical history data of the case of M4 C admitted to our hospital was reviewed. The results of bone marrow cell morphology, cytochemical stains, bone marrow biopsy, immunophenotype, cytogenetics, molecular test and NGS(next-generation sequencing) of the case were analyzed. Results The bone marrow smear showed markedly active proliferation of bone marrow cells in which the myelomonocytic cells accounted for 85.6%. Cytochemical stains showed peroxidase(POX) stain partially and weakly positive;specific esterase AS-DCE partially positive;non-specific esterase α-NBE partially positive and smothered by sodium fluoride;non-specific esterase AS-DAE partially positive and smothered by sodium fluoride. Bone marrow biopsy showed hyperproliferative cells and diffused hyperplasia of blasts. Immunophenotype analysis showed that the abnormal cell population was positive for CD11 B, CD64, CD56, cMPO, CD33, CD41, CD61, CD38 and CD58, but negative for CD13, CD34, CD117, CD7, CD123, HLA-DR, CD10, CD19, CD20, CD2, CD14, CD235, CD15, CD303, CD304, CD25, cCD79 a, cCD3, cCD22, CD1 a and TDT. Cytogenetic analysis showed 47, XY, t(9;11)(p22;q23),+mar. The molecular test for leukemia showed MLLT3/KMT2 A gene rearrangement. NGS showed NRAS and TET2 mutation. The case was finally diagnosed as AML(acute myelomonocytic leukemia) M4 C with t(9;11)(p22;q23), MLLT3-KMT2 A. Conclusion Leukemia M4 C may show the characteristics of both granulocytes and monocytes with complex morphological features. The combined examination of MICM should be necessary for the diagnosis of M4 C with great significance.

关 键 词：急性粒单核细胞白血病 M4C MICM分型 

分 类 号：R446[医药卫生—诊断学]