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Adult acute leukemia: hand mirror cell variant
A Wibowo1, D Pankowsky, A Mikhael
1Department of Pathology and Laboratory Medicine, University of Cincinnati, Ohio 45267-0529, USA.
Insights
Researchers identified a unique subset of acute mixed leukemia characterized by hand mirror cells and specific immune markers. This finding aids in diagnosing and understanding these rare leukemia cases.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Acute mixed leukemia (AML) is a rare subtype of leukemia.
- Hand mirror cells (HMCs) are observed in some leukemic cells.
- The immunophenotype of HMC-AML requires further elucidation.
Observation:
- Two patients with HMC in bone marrow underwent comprehensive analysis.
- Both patients exhibited a mixed immunophenotype with myeloid and T-lymphoid features.
- Strong expression of CD2, CD7, and CD11b was noted.
Findings:
- A distinct subset of HMC-AML cases shows co-expression of myeloid and T-lymphoid markers.
- The expression of adhesion molecules like CD2, CD7, and CD11b may drive the hand mirror configuration.
- This suggests an additional stimulatory event beyond normal adhesion molecule function.
Implications:
- Accurate diagnosis of HMC-AML requires detailed immunophenotypic and cytogenetic analysis.
- Understanding the role of adhesion molecules in HMC-AML can impact prognosis and treatment strategies.
- Further research into this unique leukemia subset may reveal novel therapeutic targets.
Abstract:
Two patients with numerous hand mirror cells in the bone marrow were investigated by morphologic, cytochemical, immunohistochemical, flow cytometric, cytogenetic, and gene rearrangement analysis. Both demonstrated a mixed immunophenotype with expression of myeloid and T-lymphoid features. Interestingly, both strongly expressed CD2 (adhesion molecule) and CD7. Review of the literature uncovered additional cases of acute mixed leukemia--hand mirror variant with strong expression of CD2, CD7, and CDIIb, suggesting a unique subset. Under normal physiologic conditions lymphoid cells and monocytes assume a hand mirror configuration when adhesion molecules (i.e., CD2, CDIIb) are triggered by their corresponding ligands. Evidently not all acute leukemias with surface adhesion molecules form hand mirrors, which suggests an additional stimulatory event. The presence of adhesion molecules on these activated cells is important to homing, trafficking, spread of the malignant cells, clinical course, prognosis, and treatment. Therefore all HMC cases require detailed analysis to ensure accurate diagnosis. In-depth evaluation of such cases should give new insights into clinical presentation, prognosis, and treatment of these unusual cases.