Mike: In relationship to your case, I believe that is a real challenge. Although there are more opinions that favor an AML MO, I will like to propose in consideration an AUL type IV or V based in these facts: Mike's case showed CD33 and MPO negativity with dim CD13. I will like to see CD33 dim or clear positivity for AML MO. But, it is not the case. In the other hand, there is CD7 and TdT positivity with other T cell markers negatives that "may" suggest an early T cell differentiation. Also, It is DR positive with other B cell markers negative. So, there is not clear lineage definition although there is evidence that the malignant clone start to differentiate. AUL type V (with CD7 + and negative CD4 and CD8) is associated clinically with bulky disease, mediastinal widening, leukocytosis. BM transplant will be the best treatment. I agree with Anita that is important to exclude very early B or megacaryocytic compromise, although as she wrote it is unlikely. I believe that this case in one of those that will create different opinions, all of them very interesting and will be important to know either molecular and cytogenetic studies that can complement our comments and in that way our understanding of these atypical phenotypes will be better for future cases. I will like to take this opportunity to inform my colleagues that I have moved from Manchester, England to the MD Anderson, Houston. Sincerely: Cesar Nunez, MD Department of Pediatrics MD Anderson Cancer Center
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