versão impressa ISSN 1516-8484
Rev. Bras. Hematol. Hemoter. v.26 n.3 São José do Rio Preto 2004
IMAGES IN HEMATOLOGY IMAGENS EM HEMATOLOGIA
Analise morfológica, citogenética e molecular na identificação da leucemia promielocítica aguda
Gustavo J. LourençoI; Rosemeire A. V. BognoneII; Maristela ZoccaIII; Marcia T. DelamainIV Afonso C. VigoritoV; Carmen S. P. LimaVI
IPós-graduando em mestrado do Departamento de Clínica Médica da Faculdade de Ciências Médicas da Unicamp
IIBióloga responsável pelo Laboratório de Citogenética do Hemocentro da Unicamp
IIIBióloga do Laboratório de Citogenética do Hemocentro da Unicamp
IVMédica Assistente do Hemocentro da Unicamp
VMédico Assistente do Hemocentro da Unicamp
VIProfessora Doutora da Disciplina de Oncologia Clínica, do Departamento de Clínica Médica, da Faculdade de Ciências Médicas da Unicamp
The association of an exaggerated haemorrhagic syndrome with certain leukaemias was described by Croizat & Favre-Gilli in 1949, 1 and in 1957 Hillstad 2 bestowed the appellation acute promyelocytic leukaemia (APL) upon this morphologic-clinical syndrome of acute myelogenous leukaemia (AML). This variant is called M3 in the FAB classification, and is characterised by the infiltration of bone marrow by promyelocytes. The haemorrhagic manifestations result, particularly, from procoagulant release by promyelocytes, and frequently determine fatal evolutions for these patients.
A translocation between chromosomes 15 and 17 t(15;17)(q22;q11-21) is present in most, maybe all, cases of APL 3 but this is not found in other AML subtypes. In addition, several descriptions exist of patients with seemingly classic APL but with variant translocations between 15q, 17q and a third chromosome.3,4
As a result of the translocation t(15;17) or its variants, the retinoic acid receptor gene (RARA) from chromosome 17 is moved to chromosome 15, where it is fused with a gene called PML to give rise to a new PML/RARA hybrid gene.3-6
A clinically intriguing correlate of the molecular genetic detection of a PML/RARA rearrangement in APL is the remarkable, albeit temporary, response to all-trans retinoic acid (ATRA) treatment. After an initial transient proliferation, the APL cells differentiate senesce and die. In consequence, a decrease in mortality by hemorrhagic manifestations has been seen in treated patients.
Herein, we present, for educational purposes, the images obtained from morphologic (Figure 1), cytogenetic (Figure 2), and molecular (Figure 3) analyses of a APL case seen at the Haematology and Haemotherapy Centre of the State University of Campinas.
It is important to comment that the patient was initially treated with ATRA attaining haematologic remission without significant haemorrhagic episodes. Another finding to be mentioned was the presence of the PML-RARA rearrangement in the variant translocation found in the case.
1. Croizat P, Favre-Gilli J. Les aspects du syndrome hemorrhagigue des leucémies. Sangre 1949;20:417.
2. Hillstad LK. Acute promyelocytic leukemia. Acta Med Scand 1957;159:189.
3. Heim S, Mitelman F. In: Acute myeloid leukemia. In: Heim S, Mitelman F. Cancer Cytogenetics. 2nd ed. New York: Willey-Liss 1995, p.69-140.
4. Grignani F, Fagioli M, Alcalay M et al. Acute promyelocytic leukemia: from genetics to treatment. Blood 1994;83:10-25.
5. Alcalay M, Zangrilli D, Pandolfi PP et al. Translocation breakpoint of acute promyelocytic leukemia lies within the retinoic acid receptor a locus. Proc Natl Acad Sci USA 1991;88:1.977-81.
6. Miller WH, Levine K, De Blassio A et al. Detection of minimal residual in acute promyelocytic leukemia by a reverse transcription polymerase chain reaction assay for the PML/RARa fusion mRNA. Blood 1993;82:1.689-94.
Carmen Silvia Passos Lima, MD, PhD
Hemocentro Unicamp Cidade Universitária "Zeferino Vaz"
Caixa Postal 6198, Cep: 13083-970 Campinas, SP Brazil
Phone: + 55 19 3788-8740 Fax: + 55 19 3788-8600
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