Case presentation
A 28-year-old non-smoker man initially presented with severe fatigue for
a few weeks. He had been diagnosed with mild anemia, but no therapy was
given. He also reported weakness and nighttime headaches. For any
malignancies, his family history was unremarkable. During the
examination, the patient’s vital signs were found to be within the
expected range of values. There was no observation of lymphadenopathy or
splenomegaly. Lung and heart examinations were unremarkable. The initial
complete blood count revealed a total leukocyte count of 4530/mm3. (48%
blasts, 53.6% Neutrophils, 24.4% Lymphocytes), hemoglobin of 8.6
gm/dl, and a platelet count of 60,000/mm3 (Table 1). He was admitted to
the Hemato-oncology ward due to his Bi-cytopenia.
His peripheral blood smear showed 5000/mm3 white blood cell counts with
50% Polymorph nuclear
leukocytes (PMNs), 20%
immature cells, 22% lymphocytes, and 8% monocytes with a platelet
count of 60000/mm3 (Table 3). Red blood cells were hypochromic
microcytic with Teardrops and anisocytosis. A diagnostic test for AML is
a bone marrow biopsy. (Fig.2) It should also be noted that evaluating
essential gene mutations such as FLT3 and NPM1c in our center was
impossible. Additional diagnostic procedures, including a peripheral
blood smear, bone marrow aspiration, and biopsy, were conducted in order
to exclude the possibility of acute leukemia. His second
PBS showed
WBC: 10000/mm3 with PMN 46%,
lymph18%, mono:8%, and blast:28%. Samples of bone marrow were taken
for immunophenotypic, morphologic, and genetic analysis. His bone marrow
aspiration and biopsy were reported as diluted without particles, but
about 80% of cells were seen in filtered blasts.
In the cells analyzed, cytogenetic examination revealed an aberrant male
chromosomal complement, with the only aberration being a translocation
between the short arm of chromosome 3 and the long arm of chromosome X
(Fig.1). This translocation is a brand-new anomaly in hematological
malignancies that hasn’t been documented in any of the references (such
the Mitelman database). At first, we suspected a congenital anomaly, but
after routinely culturing mitogen-stimulated peripheral blood cells, we
found that the abnormality was disease-related and absent in normal
cells. In his flow cytometry, CD13, CD33, CD45, CD117, and HLA-DR were
50%, 61%, 83%, 33%, and 46% reported, respectively (Table 2). The
flow cytometric analysis and morphology revealed that the case was
diagnosed with AML.
Induction chemotherapy was started for the patient with 7+3(cytarabine
100mg/m2/day continuous IV
infusions for seven days and danorubicinb12mg/m2/day for three days). On
his first and last induction days,
CBC was reported in Table 1.
After the end of the chemotherapy induction, the patient was discharged
from the hospital in a wealth condition. The patient is also under the
supervision of our center doctors for further treatment and follow-ups.