CPC Sept 2003

1
CPC Sept 2003
Fiji School of Medicine Colonial War
Memorial Hospital, SUVA Fiji Islands.

• Child with CML

2
Clinical Details

• 11 year old Fijian Girl, Presented with weakness,
  painful limp in left leg since 3 months. No
  history of trauma.
• Generalized scabies resistant to treatment. Vital
  signs stable, active.
• Generalized lymphadenopathy, liver 3 finger
  palpable, Spleen just palpable.

3
Clinical Details

• Mild anemia, WBC count over 100,000,
  neutrophilia, eosinophilia,
• markedly increased platelets. No differential by
  analyzer.
• Bone marrow done.

4
Blood Film Features

• RBC normocytic normochromic.
• Marked Leucocytosis.
• All stages of myelocyte development seen.
• Predominant eosinophilic neutrophilic
  myelocytes seen.
• Markedly increased platelets.
• Basophilia moderate.
• Occassional blasts myeloid.

5
Bone marrow Features

• Adequate sample, Marked hypercellularity.
• Myeloid hyperplasia, suppressed erythropoiesis.
• Increased megakaryocytes with plenty microforms
• Increased mitotic figures, abnormal.
• Blasts 4 - myeloid.

6
Bone marrow
Hypercellular marrow particle
7
Bone marrow
8
Bone marrow
9
Bone marrow
10
Bone marrow
Mitotic fig.
11
Bone marrow
Mitotic fig.
Eosinophil
12
Bone marrow
13
Bone marrow
Neutrophil
Promyelocyte
Monocyte
14
Discussion

• This child has presented with features of
  Juvenile CML clinically such as generalized
  lymphadenopathy, skin lesions.
• but age 11 years is against. JCML is common in
  infants and children less than 4 years.
• Blood film and Bone marrow findings support
  typical CML in remission.
• Adult type CML is seen in children (3 of
  childhood leukemias).

15
Discussion

• Hematological features in blood film and bone
  marrow suggest adult type CML.
• Clinical features of Generalized lymphadenopathy
  and skin lesions suggest Juvenile CML.
• Bone marrow shows some predominance of monocytic
  differentiation at some places which is seen in
  Juvenile CML.
• Is this a rare type of JCML, or adult CML?
• Molecular study is needed to confirm. Ph
  chromosome, BCR-ABL fusion gene is negative in
  JCML.