Presentation
Although eosinophilia is characteristic of these diseases, the clinical presentation of the three entities is variable. [ncbi.nlm.nih.gov]
In patients who present with CEL there may be subsequent transformation to AML, T or B lymphoblastic leukaemia or MPAL. [viapath.co.uk]
Here, we discuss the case of 51 year old man who presented with nodal myeloid sarcoma mimicking lymphoma as the presenting feature of his FIP1L1 - PDGFRA myeloid neoplasm. [jscimedcentral.com]
A minority of patients present with acute leukemia, either myeloid or T-lymphoblastic with preceding eosinophilia being documented or being present at the time of diagnosis. 5 The prototype of this group of neoplasms is CEL associated with a FIP1L1-PDGFRA [clinicalgate.com]
Clinics Patients typically present with splenomegaly with hepatomegaly being less frequent; lymphadenopathy may also be seen. As with abnormalities of PDGFRA, skin and cardiac infiltration may be present at diagnosis with resulting cardiac damage. [atlasgeneticsoncology.org]
Immune System
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Cervical Lymphadenopathy
Two patients had generalized lymphadenopathy and splenomegaly (cases 137 and 246), and one patient had cervical lymphadenopathy (case 12). [ajcp.oxfordjournals.org]
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Generalized Lymphadenopathy
Two patients had generalized lymphadenopathy and splenomegaly (cases 137 and 246), and one patient had cervical lymphadenopathy (case 12). [ajcp.oxfordjournals.org]
Entire Body System
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Fishing
Conventional cytogenetics (karyotyping) will detect the majority of abnormalities involving PDGFRB and FGFR1, but florescence in situ hybridization (FISH)/molecular studies are required to detect factor interacting with PAP (FIP1L1)-PDGFRA as the characteristic [ncbi.nlm.nih.gov]
For these considerations, one can submit peripheral blood for FISH - BCR/ABL t(9;22), FISH -del 4q12; and PCR for JAK2 V617F mutation. [mplnet.com]
Description: TESTS AVAILABLE: Karyotyping and FISH. [viapath.co.uk]
Test Methodology Fluorescence In Situ Hybridization (FISH) Analysis. Interpretation A positive FISH result indicates deletion of the CHIC2 gene which lies between the FIP1L1 and PDGFRa loci in band 4q12. [beaumontlaboratory.com]
Analysis by FISH confirmed FGFR1 gene rearrangement in all samples. [ajcp.oxfordjournals.org]
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Pathologist
Outstanding images make this an invaluable diagnostic aid for every practicing pathologist, resident, or fellow. [books.google.com]
[…] survivals of less than 18 months (since individuals meeting these criteria for TKI resistance may often live longer than 18 months), or whether a new conceptual framework for defining AP disease in the modern TKI era needs to be considered by clinicians and pathologists [hematology.org]
He is member and fellow of Royal College of Pathologists, UK. He is currently Medical Director of National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi and Director Stem Cell Research. [actamedicainternational.com]
• In 2014, a clinical advisory committee (CAC) composed of 100 pathologists, haematologists, oncologists and geneticists from around the world convened to propose revisions to the fourth edition of the WHO classification. 3. [slideshare.net]
However, we have observed other pathologists use this designation as a diagnosis in pathology reports, with resulting clinicians’ dissatisfaction. [ajcp.oxfordjournals.org]
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Severe Pain
A 35-year-old male was admitted to hospital in September 1989 with severe pain and swelling in the right ankle. No fever and no systemic symptoms were observed. [cancerres.aacrjournals.org]
Gastrointestinal
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Abdominal Mass
Concurrent computerized tomography (CT) of the abdomen and pelvis also detected enlarged retroperitoneal lymph nodes, a large abdominal mass, and bone metastases. A CT guided biopsy of the abdominal mass revealed low-grade follicular lymphoma. [hoajonline.com]
Cardiovascular
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Vascular Disease
diseases Kimura disease Vasculitis Cyclical eosinophilia Aberrant T cell population associated eosinophilia Also known as lymphocyte variant hypereosinophilia Abnormal T cell population does not meet diagnostic criteria for leukemia or lymphoma Causes [surgpathcriteria.stanford.edu]
Skin
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Skin Lesion
As in the case described here, some patients also displayed skin lesions, and it is conceivable that these arise as a consequence of aberrant PDGFRB signaling because this receptor is normally involved in wound healing and repair of skin lesions. [cancerres.aacrjournals.org]
Musculoskeletal
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Back Pain
Subsequently, the patient developed worsening of the back pain and lower extremity numbness. CBC at this time showed leukocytosis (9,900/µl) with absolute eosinophils of 3,000/µl. [jscimedcentral.com]
Case 90 was from a man who had severe back pain, splenomegaly, and bilateral pelvic lymphadenopathy. A fine-needle aspiration of the lymph node showed myeloid sarcoma. [ajcp.oxfordjournals.org]
Workup
Biopsy
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Hypercellular Bone Marrow
(Wright Giemsa stained peripheral blood smear, original magnification 1000x) A markedly hypercellular bone marrow with myeloid hyperplasia including many eosinophils is appreciated. [atlasgeneticsoncology.org]
Treatment
This issue of Emerging Cancer Therapeutics provides a comprehensive review for practitioners on the current status of leukemia treatment. [books.google.com]
Resolution of a steroid-resistant, hypereosinophilic immune diathesis with mepolizumab and concomitant amelioration of a mixed thrombotic microangiopathy, Blood Cells, Molecules, and Diseases, 2017 CrossRef 6 Jason Gotlib, Tyrosine Kinase Inhibitors in the Treatment [onlinelibrary.wiley.com]
BCR/ABL1 tyrosine kinase inhibitors (TKIs ) have been developed as a first line treatment for patients with CML. These include Imatinab and Desatinab but there are also other treatments. [viapath.co.uk]
Conclusion We firstly demonstrated that therapy-related myeloid neoplasm with TRIP11-PDGFRB fusion was identified after treatment of APL. [molecularcytogenetics.biomedcentral.com]
View Figure 2 Figure 3: A) (pre-treatment): FISH using a dual-color ETV6 break-apart probe; B) (pre-treatment): FISH using a dual-color PDGFRB break-apart probe; C) (post-treatment): FISH using a dual-color PDGFRB break-apart probe, rearrangements is [clinmedjournals.org]
Prognosis
Imatinib mesylate (imatinib) is the first-line therapy for patients with abnormalities of PDGFRA/B, whereas patients with FGFR1 fusions are resistant to this therapy and carry a poor prognosis. [ncbi.nlm.nih.gov]
[…] definition to require biallelic mutations. • A provisional category of AML with mutated RUNX1 has been added to the classification for cases of de novo AML with this mutation which has possibly worse prognosis than other AML types. 39. [slideshare.net]
Disease prognosis relies on accurately classifying the eosinophilia. [eposters.net]
Prognosis In a previously reported case-control study, the overall risk of thrombotic episodes in patients with ET was 6.6% per patient-year compared with 1.2% per patient-year in the control group. 12 A history of thrombosis (31.4% per patient-year) [oncohemakey.com]
[…] kinases or cytokine receptors (“BCR-ABL1–like ALL”) association with an adverse prognosis responses of some cases to TKI therapies Early T-precursor (ETP) ALL leukemia : Early T-precursor (ETP) ALL leukemia Early T-cell differentiation, with retention [authorstream.com]
Epidemiology
Anemia Cardiac damage/failure Elevated white cell count Hepatomegaly Serum tryptase mild to moderately elevated Skin infiltration Splenomegaly Thrombocytopenia Diagnostic Exams Immunophenotyping Peripheral blood smear Progression and Transformation None Epidemiology [seer.cancer.gov]
[…] mycobacterial diseases due to partial STAT1 deficiency Susceptibility to viral and mycobacterial infections Synonym(s): (no synonyms) Classification (Orphanet): - Rare hematologic disease - Rare oncologic disease Classification (ICD10): (no data available) Epidemiological [csbg.cnb.csic.es]
Epidemiology Myeloid and lymphoid neoplasms with eosinophilia and abnormalities of PDGFRB (as well as abnormalities of PDGFRA and FGFR1) are rare. [atlasgeneticsoncology.org]
Pathophysiology
Pathophysiology and treatment of the myelodysplastic syndrome with isolated 5q deletion. Haematologica. 2010 Mar 1;95(3):348-51 ; PMid:20207839 PMCid:PMC2833060. 7. Gokalp-Yasar D, Liu JM. [actamedicainternational.com]
Prevention
Diagnostic criteria for polycythemia vera (PV) are notably changed to lower the hemoglobin threshold and thus prevent underdiagnosis. [hematology.org]
[…] modelling of the PDGFRβ TKD suggested that the residue in 3 position, R853, which differs from corresponding sites in all other RTKs of the PDGFR family, mediates a critical amino acid interaction stabilizing the A-loop in the active conformation, thereby preventing [ncbi.nlm.nih.gov]
• So required haemoglobin levels as a criteria are reduced and incorporated with PV bone marrow morphology to prevent underdiagnoses of PV. 17. Polycythemia vera 18. [slideshare.net]