Acute undifferentiated leukemia (stem cell acute leukemia) showing differentiation to Langerhans cell-like cells in
Takanori Fukuta1, Shu Nakamoto, Yoshinori Hashimoto
1Department of Pathology, Tottori Prefectural Central Hospital.
Insights
This study details a rare leukemia case where malignant cells with trisomy 10 appeared to differentiate into Langerhans cell-like cells. This finding offers new insights into myeloid leukemia pathogenesis and cell differentiation.
Area of Science:
- Hematology
- Oncology
- Cell Biology
Background:
- Leukemia is a cancer of blood-forming tissues, often characterized by abnormal white blood cells.
- Langerhans cell hyperplasia can occur in various conditions, but its association with leukemia differentiation is rare.
Observation:
- A 75-year-old woman presented with suspected leukemia, showing specific blood counts and bone marrow blast morphology.
- Bone marrow analysis revealed blasts expressing CD34, CD7, TdT, CD33, and CD117, with MPO negativity.
- Cytogenetic analysis identified isolated trisomy 10 in all leukemic cells.
Findings:
- Cervical lymph node biopsy showed leukemic blasts with a similar phenotype, alongside proliferating Langerhans cell-like cells (LCs).
- These LCs exhibited characteristic morphology (pale cytoplasm, grooved nuclei) and immunophenotype (CD1a+, S100+).
- Fluorescence in situ hybridization confirmed trisomy 10 in both leukemic blasts and LCs, suggesting a shared clonal origin.
Implications:
- This case provides compelling evidence for leukemic cell differentiation into Langerhans cell-like cells.
- The findings suggest a potential myeloid leukemia differentiation pathway previously not well-defined.
- Understanding this phenomenon may impact future diagnostic and therapeutic strategies for specific leukemia subtypes.
Abstract:
A 75-year-old woman was referred to our hospital with suspected leukemia. Complete blood count demonstrated WBC 3,810/µl with 26% blasts, Hb of 11.7 g/dl and Plt of 18.0×104/µl. Bone marrow aspiration revealed blasts (86.3%) with expressions of CD34, CD7, TdT, CD33, and CD117. MPO was negative. Chromosomal analysis of the bone marrow showed isolated trisomy 10 in all leukemic cells (20/20). Swelling of superficial lymph nodes was also observed. Cervical lymph node biopsy revealed leukemic blasts which had the same phenotype as those in the bone marrow except that proliferation of Langerhans cell-like cells (LCs) was observed in the paracortex. LCs had pale cytoplasm and grooved nuclei, and were positive for both CD1a and S100 protein. Trisomy 10 was detected in both the leukemic blasts and the LCs by fluorescence in situ hybridization. This rare case strongly suggests leukemic cells to differentiate into LCs.
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