A Fatal Case of Chronic Eosinophilic Leukemia Not Otherwise Specified (CEL-NOS) in a 19-Year-Old Male with Acute Transformation into Blast Crisis  

作　　者：Basheer Al-Sanouri Basheer Al-Sanouri Yahya Maslamani Ibrahim Al-Sanouri Basheer Al-Sanouri;Basheer Al-Sanouri;Yahya Maslamani;Ibrahim Al-Sanouri(College of Science, Michigan State University, Lansing, MI, USA;Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia;Department of Pulmonary and Critical Care, Allergy and Immunology, Gunderson Health System, University of Wisconsin, La Crosse, WI, USA)

机构地区：[1]College of Science, Michigan State University, Lansing, MI, USA [2]Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia [3]Department of Pulmonary and Critical Care, Allergy and Immunology, Gunderson Health System, University of Wisconsin, La Crosse, WI, USA

出　　处：《Case Reports in Clinical Medicine》2016年第12期528-540,共14页临床医学病理报告（英文）

摘　　要：Chronic eosinophilic leukemia (CEL) is a rare disorder that is characterized by hypereosinophilia with increased number of blood or marrow blasts (>5% and <20%). CEL is distinguished from hypereosinophilic syndrome (HES) by the presence of eosinophilic clonality. Chronic eosinophilic leukemia not otherwise specified (CEL-NOS) diagnosis is made when no fusion genes are detected by most modern molecular testing, particularly the most common fusion gene FIP1L-1/PDGFRA (Factor Interacting with PAP like-1/Platelet-Derived Growth Factor Receptor Alpha). This disease is very rare, and its description in the literature is not well characterized. We report a fetal case of severe CEL-NOS in a 19-year-old male who presented with a plethora of clinical features consists of constitutional symptoms, pancytopenia, intravascular thrombosis, acute stroke and endomyocardial infiltrates. The course of his disease was aggressive and resistant to conventional treatment. After a short period of improvement, an acute transformation into blast crisis (BC) had occurred. The diagnosis was confirmed by morphology and immunophenotyping of bone marrow biopsy. The patient eventually died of heart failure and sepsis. To our knowledge this is the first case report of fatal CEL-NOS transforming into severe blast crisis.Chronic eosinophilic leukemia (CEL) is a rare disorder that is characterized by hypereosinophilia with increased number of blood or marrow blasts (>5% and <20%). CEL is distinguished from hypereosinophilic syndrome (HES) by the presence of eosinophilic clonality. Chronic eosinophilic leukemia not otherwise specified (CEL-NOS) diagnosis is made when no fusion genes are detected by most modern molecular testing, particularly the most common fusion gene FIP1L-1/PDGFRA (Factor Interacting with PAP like-1/Platelet-Derived Growth Factor Receptor Alpha). This disease is very rare, and its description in the literature is not well characterized. We report a fetal case of severe CEL-NOS in a 19-year-old male who presented with a plethora of clinical features consists of constitutional symptoms, pancytopenia, intravascular thrombosis, acute stroke and endomyocardial infiltrates. The course of his disease was aggressive and resistant to conventional treatment. After a short period of improvement, an acute transformation into blast crisis (BC) had occurred. The diagnosis was confirmed by morphology and immunophenotyping of bone marrow biopsy. The patient eventually died of heart failure and sepsis. To our knowledge this is the first case report of fatal CEL-NOS transforming into severe blast crisis.

关 键 词：Hypereosinophilic Syndrome (HES) Eosinophils Degranulation WHO World Health Organization Classification Chronic Eosinophilic Leukemia Not Other-wise Specified (CEL-NOS) Fluorescent In Situ Hybridization (FISH) Tyrosine Kinase Inhibitor Imatinib Acute Transformation into Blast Crisis 

分 类 号：R73[医药卫生—肿瘤]