difficult diagnosis

From: Ugo Consoli (uconsoli@mbox.vol.it)
Date: Tue Feb 03 1998 - 17:41:46 EST


Dear flow friend
we have a 38 y/o woman whose diagnosis is challenging us.
She was admitted in our hospital for deep anemia (6 gr/dl) and low
platelets count (15000 mmc) discovered during a routine blood test after an
antibiotic resistant fever.
Clinically the patient has and enlarged spleen (4 cm below the costal
arch), an enlarged mediastinum caused by the presence of several
lymphonodes, and a pleural effusion.
The blasts looks like small undifferentiated cells and we have found
several figures of emophagocitosis.
The immunophenotype of the cells is:
CD7 positive (strong)
CD5 positive (dim)
CD45 positive (dim)
Gly-A positive (dim in 35% of the cell, but this monoclonal sometimes give
us questionable results!)
all the other markers we have tested are negative including:
CD2, cCD3, sCD3, CD4, CD8, CD9, CD10, CD11c, CD13, CD14, CD19, CD20, cCD22,
sCD22, CD33, CD34, CD36, CD41, CD42, CD117, DR.
Tdt is also negative as well as mieloperroxidase with the exxception of 1%
of the CD7 cells which are double positive for CD7 and MPO.

Tomorrow we will stain our cells with CD1, MAC and few other MoAbs which
are positive on hystiocytes and macrophages but  we are anxious to have
some clues from the discussion group.

Cytogenetic is on the way.

Thank you for your advices.
------------------------------------------
Ugo Consoli, M.D.
Institute of Hematology
University of Catania, Italy
Fax  ++39-95-7311510
Tel. ++39-95-7435917   -  7435922



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