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.