complex karyotype

复杂核型
  • 文章类型: Case Reports
    这是诊断为急性髓细胞性白血病(AML)的老年患者的病例。虽然形态学发现,包括许多长,纤细,雪茄形的奥尔棒,建议使用t(8;21)的AML,细胞遗传学和FISH分析显示11号染色体和KMT2A(MLL)基因异常。患者还表现出双倍的时间,通常见于AML,并与复杂的核型和不良预后有关。将形态学发现与分子遗传学和细胞遗传学相关联对于准确诊断和治疗至关重要。
    This is a case of an elderly patient diagnosed with acute myeloid leukemia (AML). While morphological findings, including numerous long, slender, cigar-shaped Auer rods, suggested AML with t(8;21), cytogenetic and FISH analysis revealed abnormalities in chromosome 11 and the KMT2A (MLL) gene. The patient also exhibited double minutes, typically seen in AML and linked to a complex karyotype and poor prognosis. Correlating morphological findings with molecular genetics and cytogenetics is crucial for accurate diagnosis and treatment.
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  • 文章类型: Case Reports
    纯性红系白血病(PEL)是一种极其罕见的急性髓系白血病(AML)亚型。虽然不具体,PEL与复杂核型和TP53突变几乎一致相关。鉴于这种疾病的稀有性,我们对其细胞遗传学和分子特征的理解认为是不完整的。我们的目标是通过介绍一个不寻常的PEL案例来补充现有文献。此案以多种方式进行了全面处理。我们首次介绍了具有异常细胞遗传学和分子特征的PEL病例:正常核型,不存在TP53突变以及存在NPM1和NRAS突变。这是对文学的宝贵补充,扩大我们对PEL分子和细胞遗传学谱的理解。
    Pure erythroid leukemia (PEL) is an extremely rare subtype of acute myeloid leukemia (AML). Although not specific, PEL is almost uniformly associated with complex karyotype and TP53 mutations. Given the rarity of the disease, our understanding of its cytogenetic and molecular features deems incomplete. We aim to complement existing literature by presenting an unusual case of PEL. The case is comprehensively worked up with multiple modalities. We present for the first time a case of PEL with unusual cytogenetic and molecular features: normal karyotype with absence of TP53 mutations and presence of NPM1 and NRAS mutations. This is a valuable addition to literature, expanding our understanding of molecular and cytogenetic spectra of PEL.
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  • 文章类型: Case Reports
    急性早幼粒细胞白血病(APL)是一种医疗紧急情况。APL的诊断需要形态学检查,细胞化学,免疫表型,和用于PML::RARA或其变体的逆转录酶聚合酶链反应(RT-PCR)。然而,由于并发症的迅速发展,诊断通常依赖于形态学和细胞化学进行早期治疗。在这里,我们描述了一位72岁的绅士,他患有全血细胞减少症,被诊断为急性早幼粒细胞白血病,形态异常。骨髓涂片显示80%的髓细胞样细胞具有突出的颗粒和成熟停滞,偶有中性粒细胞.在仔细重新检查外周涂片和骨髓后,偶尔发现一个保存不良的细胞,带有一束Auer棒。在异常的早幼粒细胞中,MPO的细胞化学强阳性,流式细胞术显示MPO阳性,CD13,CD33和CD117,CD34和HLA-DR阴性。细胞遗传学显示45,XY的复杂核型,-14,t(15;17)(q24;21)t(14;21)(q11.2;p13)[10]/45,XY,idem,添加(5)(q35)[5]/45,X,-Y[5]。PML-RARA的RT-PCR对bcr-3转录物呈阳性,而FISH对t(15;17)(q24;q21)呈阳性。从我们的案例中得到的重点是,每当存在全血细胞减少症,并存在具有明显颗粒的髓细胞样细胞时,寻找具有Auer杆束的细胞的存在。
    Acute promyelocytic leukemia (APL) is a medical emergency. The diagnosis of APL requires morphological examination, cytochemistry, immunophenotyping, and reverse transcriptase polymerase chain reaction (RT-PCR) for PML::RARA or its variants. However, due to the rapid development of complications, diagnosis often relies on morphology and cytochemistry for early treatment. Herein, we describe a 72-year-old gentleman who presented with pancytopenia diagnosed as acute promyelocytic leukemia with an unusual morphology. The bone marrow smear showed 80% myelocyte-like cells with prominent granules and maturation arrest, with an occasional neutrophil. On careful re-examination of the peripheral smear and bone marrow, an occasional poorly preserved cell with a bundle of Auer rods was identified. Cytochemistry for MPO was strongly positive in abnormal promyelocytes and flow cytometry showed positivity for MPO, CD13, CD33, and CD117 and was negative for CD34 and HLA-DR. Cytogenetics showed a complex karyotype of 45,XY, -14, t(15;17)(q24;21)t(14;21)(q11.2;p13)[10]/ 45, XY, idem, add(5)(q35)[5]/ 45,X,-Y[5]. RT-PCR for PML-RARA was positive for the bcr-3 transcript and FISH was positive for t(15;17) (q24;q21). The take home point from our case is to look for the presence of cells with bundle of Auer rods whenever there is pancytopenia with the presence of myelocyte-like cells with prominent granulations.
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  • 文章类型: Case Reports
    背景:慢性淋巴细胞白血病(CLL),西方国家最常见的白血病,是一种成熟的B细胞慢性淋巴增殖性疾病,其特征是肿瘤CD5+B淋巴细胞的积累,功能上无能,通常是单克隆起源,在骨髓中,淋巴结和血液。诊断主要发生在老年患者,据报道,中位年龄在67至72岁之间。CLL具有异质性的临床病程,它可以从惰性到,不那么频繁,侵略性的形式。早期无症状CLL患者不需要立即治疗干预,但只能观察;对于晚期疾病或观察到“活动性疾病”的患者,治疗是必要的。最常见的自身免疫性血细胞减少症(AIC)是自身免疫性溶血性贫血(AHIA)。CLL中AIC出现的主要机制尚未完全阐明,CLL患者自身免疫性并发症的易感性是可变的,自身免疫性血细胞减少症可以发生,并发,或遵循CLL的诊断。
    方法:一名74岁的男子在当天进行血液检查时发现严重的大细胞性贫血后被送进急诊室,特别是该患者表现出几个月前的严重虚弱。回忆是沉默的,患者没有服用任何药物。血液检查显示,在CLL型成熟B细胞淋巴增殖性肿瘤中,白细胞计数和AIHA的发现极高。遗传研究:进行了常规的核型分析,它获得了8三体和6号染色体短臂与11号染色体长臂之间的不平衡易位,同时染色体6q和11q中的间质缺失无法详细定义。分子细胞遗传学(FISH)分析显示共济失调性毛细血管扩张突变(ATM)单等位基因缺失(在衍生染色体11上丢失了ATM),并保留了TP53,13q14和着丝粒12FISH探针的信号。TP53和IGHV未发生突变。Array-CGH证实了整个8号染色体的三体性,并使我们能够详细解决不平衡易位的性质,揭示了染色体6和11上的多个基因组丢失区域。
    结论:本病例报告是一个不寻常的CLL病例,具有复杂的核型和基因组阵列在基因水平上的所有断点的细化。从基因的角度来看,正在研究的案例呈现出几个特点。
    结论:我们报告了一名突发性疾病的CLL患者的遗传发现,到目前为止,尽管存在不同的遗传不良特征,包括ATM缺失,复杂核型和染色体6q显色事件。我们的报告证实,单独的间期FISH无法提供选定CLL病例的整个基因组景观的概述,并且需要其他技术来达到患者的适当细胞遗传学分层。
    BACKGROUND: Chronic lymphocytic leukemia (CLL), the most common leukemia in Western countries, is a mature B-cell chronic lymphoproliferative disorder characterized by the accumulation of neoplastic CD5+ B lymphocytes, functionally incompetent and usually monoclonal in origin, in bone marrow, lymph nodes and blood. Diagnosis occurs predominantly in elderly patients, with a median age reported between 67 and 72 years. CLL has a heterogeneous clinical course, which can vary from indolent to, less frequently, aggressive forms. Early-stage asymptomatic CLL patients do not require immediate therapeutic intervention, but only observation; treatment is necessary for patients with advanced disease or when \"active disease\" is observed. The most frequent autoimmune cytopenia (AIC) is autoimmune haemolytic anaemia (AHIA). The main mechanisms underlying the appearance of AIC in CLL are not fully elucidated, the predisposition of patients with CLL to suffering autoimmune complications is variable and autoimmune cytopenia can precede, be concurrent, or follow the diagnosis of CLL.
    METHODS: A 74-year-old man was admitted to the emergency room following the finding of severe macrocytic anaemia during blood tests performed that same day, in particular the patient showed a profound asthenia dating back several months. The anamnesis was silent and the patient was not taking any medications. The blood examination showed an extremely high White Blood Cell count and findings of AIHA in CLL-type mature B-cell lymphoproliferative neoplasia. Genetic investigations: Conventional karyotyping was performed and it obtained a trisomy 8 and an unbalanced translocation between the short arm of chromosome 6 and the long arm of chromosome 11, concurrent with interstitial deletions in chromosomes 6q and 11q that could not be defined in detail. Molecular cytogenetics (FISH) analyses revealed Ataxia Telangiectasia Mutated (ATM) monoallelic deletion (with loss of ATM on derivative chromosome 11) and retained signals for TP53, 13q14 and centromere 12 FISH probes. TP53 and IGHV were not mutated. Array-CGH confirmed trisomy of the entire chromosome 8 and allowed us to resolve in detail the nature of the unbalanced translocation, revealing multiple regions of genomic losses on chromosomes 6 and 11.
    CONCLUSIONS: The present case report is an unusual CLL case with complex karyotype and refinement of all breakpoints at the gene level by the genomic array. From a genetic point of view, the case under study presented several peculiarities.
    CONCLUSIONS: We report the genetic findings of a CLL patient with abrupt disease onset, so far responding properly to treatments despite the presence of distinct genetic adverse traits including ATM deletion, complex karyotype and chromosome 6q chromoanagenesis event. Our report confirms that interphase FISH alone is not able to provide an overview of the whole genomic landscape in selected CLL cases and that additional techniques are required to reach an appropriate cytogenetic stratification of patients.
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  • 文章类型: Case Reports
    骨髓增生异常综合征(MDS)是一组异质性病变,其特征在于造血干细胞(HSC)的克隆性改变。MDS通常见于60岁以上的患者,并伴有HSC分化和进入凋亡的能力下降,由于无效的造血和一定程度的外周血细胞减少,产生细胞数量增加的骨髓。大约30%的从头MDS与复杂的核型有关,定义为在同一核型中存在3个或更多的染色体异常。我们介绍了一名27岁女性因全血细胞减少症转诊的病例,他的儿子患有再生障碍性贫血.患者表现出6个月的演变图片,其特征是虚弱和无力。她的面层苍白,没有临床出血。初始实验室显示血红蛋白4.9g/dL,血细胞比容14%,平均红细胞体积96.6fL,平均细胞血红蛋白33pg,白细胞2,000个细胞/mL,中性粒细胞900细胞/mL,淋巴细胞900细胞/mL,单核细胞100细胞/mL,血小板36,000,乳酸脱氢酶357U/L进行骨髓穿刺,报告年龄的细胞过多,异质细胞,红色系列的发育不良,爆炸<5%。流式细胞术报告11%的总细胞与CD2+,CD33+,CD34+,CD38+,CD45+,CD117+,和HLA+表型表达和粒细胞系列成熟模式的变化。核型分析显示348-73,XXX,sl,t(4:10)(q35;q11.2)x(2),添加(12)(q24)x(2),1+2+3+4+5+6+7+8+9+10+11+12+13+14+15+16+17+18+19+20+21+22(26)/46,XX(2)(28)。双细胞系在含有多倍体的细胞系中占主导地位,涉及染色体4和10的长臂之间的易位,以及正常线上不确定起源的染色体12的长臂中的粘附。诊断为骨髓增生异常综合征伴过度母细胞,IPSS-2高风险的结论。在病人的进化过程中,她提出了高输血需求和反复感染,由于感染过程而死亡。患者的年龄与文献中关于MDS在较年轻时倾向于更具攻击性的报道形成对比。MDS的复杂核型使患者容易发生克隆进化;尽管如此,IPSS-R不认为是单独的预后因素。理想情况下,这组年轻患者应寻求早期有治愈性的造血干细胞移植。
    Myelodysplastic syndromes (MDS) are a group of heterogeneous pathologies that are characterized by clonal alterations in hematopoietic stem cells (HSC). MDS are usually seen in patients over 60 years of age and are accompanied by decreased ability of HSC to differentiate and enter apoptosis, producing bone marrow with increased cellularity conditioned by ineffective hematopoiesis and a degree of peripheral cytopenia. Approximately 30% of de novo MDS are associated with a complex karyotype, defined as the existence of 3 or more chromosomal abnormalities in the same karyotype. We present the case of a 27-year-old woman referred for pancytopenia, who has a son with aplastic anemia. The patient presented a 6-month evolution picture characterized by asthenia and adynamia. She presented with pale integuments and without clinical bleeding. Initial laboratories showed hemoglobin 4.9 g/dL, hematocrit 14%, mean corpuscular volume 96.6 fL, mean cell hemoglobin 33 pg, white blood cells 2,000 cells/mL, neutrophils 900 cells/mL, lymphocytes 900 cells/mL, monocytes 100 cells/mL, platelets 36,000, lactate dehydrogenase 357 U/L. Bone marrow aspirate was performed, reporting hypercellularity for age, heterogeneous cellularity, dyspoiesis in the red series, and blasts <5%. Flow cytometry reported 11% of total cells with CD2+, CD33+, CD34+, CD38+, CD45+, CD117+, and HLA+ phenotypic expression and changes in the maturation pattern of the granulocytic series. Karyotyping showed 348-73,XXX,sl,t(4:10)(q35;q11.2) x(2),add(12)(q24)x(2),1+2+3+4+5+6+7+8+9+10+11+12+13+14+15+16+17+18+19+20+21+22 (26)/46,XX(2)(28). The double cell line predominated over the one that contains polyploidies, involving translocation between the long arms of chromosomes 4 and 10 and adhesion in the long arms of chromosome 12 of indeterminate origin on the normal line. Myelodysplastic syndrome with excess blasts was diagnosed, and IPSS-2 high risk was concluded. During the patient\'s evolution, she presented a high transfusion requirement and recurrent infections, dying due to an infectious process. The age of the patient contrasts with reports in the literature that MDS tend to be more aggressive at a younger age. The complex karyotype in MDS predisposes patients to clonal evolution; despite this, it is not considered a separate prognostic factor by the IPSS-R. Ideally, this group of young patients should seek early hematopoietic stem cell transplantation with curative intent.
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  • 文章类型: Case Reports
    BACKGROUND: Xeroderma pigmentosum is a rare inherited disease characterized by extreme hypersensitivity to ultraviolet rays and predisposing to cutaneous malignancies that can appear in childhood. These manifestations are often associated with ocular lesions and sometimes with neurological disorders. The association of xeroderma pigmentosum with internal neoplasms such as acute myeloblastic leukemia is not reported with great frequency, which confirms the rarity of this occurrence.
    METHODS: A 26-year-old Moroccan women, xeroderma pigmentosum patient, was diagnosed with acute myeloblastic leukemia with a complex karyotype. Due to the adverse risk of the xeroderma pigmentosum association with acute myeloblastic leukemia and the profile of acute myeloblastic leukemia with complex karyotype and monosomy 7, which constitute factors of poor prognosis, as well as the absence of studies conceding the tolerance of the chemotherapy by patients suffering from xeroderma pigmentosum, our patient was put under low-dose cytarabine protocol with granulocyte colony-stimulating factor. Unfortunately, she died on the tenth day of chemotherapy by acute pulmonary edema of cardiogenic pace complicated by tamponade.
    CONCLUSIONS: According to reports, it is the second case showing association of xeroderma pigmentosum with acute myeloblastic leukemia. The management of these patients remains a challenge. Studies focusing on xeroderma pigmentosum patients developing hematological malignancies are necessary to better understand the most appropriate strategies and precautions for this specific case.
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  • 文章类型: Case Reports
    UNASSIGNED: A translocation t(14;19)(q32;q13) leading to a fusion of IGH and BCL3 which is a rare cytogenetic abnormality in CLL patients, has a more aggressive clinical course with a shorter time to first treatment (TTT) and worse overall survival (OS). To date, there is no literature reporting the identification of the t(14;19) in Chinese CLL patients and the reviewing the characteristic of all patients with this abnormality reported previously in the literature.
    UNASSIGNED: We first demonstrate three cases of t(14;19) translocation among the 200 CLL patients from 2017 to 2019 in our hospital. We investigated several aspects such as clinicopathologic features, cytogenetic analysis, IGHV mutations, next-generation sequencing technology (NGS), and histopathological characteristics in order to clearly define the features of this entity in Chinese patients and compare them with patients reported previously in western countries.
    UNASSIGNED: The clinical and pathological features of our three cases resemble those of earlier reports. All patients had atypical morphologic features and atypical immunophenotypes with low CLL scores detected by flow cytometry. All cases were unmutated in the IGHV mutations. Two cases showed complex karyotype and one case demonstrate missense mutations of TP53 and FBXW7.
    UNASSIGNED: In conclusion, this is the first report on IGH/BCL3-positive B-CLLs in Chinese people, which provided a comprehensive analysis of clinical and pathological characteristics. In addition to some similar clinical and laboratory features reported in the previous literature, we first found that CLL with t(14;19) has a higher possibility of being accompanied with high complex karyotype (high-CK), which is now regarded as a novel negative prognostic marker. Early identification of this abnormality in CLL patients is so important that patients can benefit from the more aggressive treatments at the onset of the disease.
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  • 文章类型: Case Reports
    背景:大约25年前,获得性染色体异常双中心dic(9;20)(p11〜13;q11)被认为是B细胞前体急性淋巴细胞白血病(BCP-ALL)的非随机畸变。然而,报告约200例。然而,双心dic(9;20)是一种微妙的异常,很容易与20和/或del(9p)混合。双中心dic(9;20)可以被发现为唯一的染色体异常,或者可以在复杂的重排中被掩盖;双中心dic(9;20)通常与CDKN2A基因的单或双等位基因丢失有关。
    方法:在此,我们报告一例16岁男性,诊断为从头前B-ALL。应用分子方法(基于阵列的多色条带(aMCB)和阵列比较基因组杂交(aCGH)),并鉴定了涉及六个染色体的独特复杂核型。它包括三个以前未报告的染色体畸变:双心dic(9;20;X),缺失del(7)(p22.2p15.2)和双中心dic(7;13)。双中心dic(9;20;X)也导致抑癌基因CDKN2A的单等位基因丢失。在成功的化疗治疗后,患者经历了继发性ALL的复发,没有复杂的核型,但缺失del(19)(p13)。不幸的是,患者在初步诊断17个月后死亡.
    结论:据我们所知,以前没有报道过与继发性ALL中此类复杂核型和缺失del(19)(p13)相关的儿童ALL.因此,复杂的核型与dicentrcdic(9;20;X)似乎表明预后不良。
    BACKGROUND: About 25 years ago, the acquired chromosome abnormality dicentric dic(9;20)(p11 ~ 13;q11) was seen described as a non-random aberration in B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Yet, about 200 cases were reported. However, dicentric dic(9;20) is a subtle abnormality which easily may be mixed up with monosomy 20 and/or del(9p). The dicentric dic(9;20) can be found as a sole chromosomal abnormality or can be masked within complex rearrangements; also, a dicentric dic(9;20) is often associated with mono- or biallelic loss of CDKN2A gene.
    METHODS: Here we report a case of 16-year-old male diagnosed with a de novo pre-B-ALL. Molecular approaches (array-based multicolor banding (aMCB) and array comparative genomic hybridization (aCGH)) were applied, and a unique complex karyotype involving six chromosomes was identified. It included three previously unreported chromosomal aberrations: dicentric dic(9;20;X), deletion del(7)(p22.2p15.2) and dicentric dic(7;13). The dicentric dic(9;20;X) also led to monoallelic loss of tumor suppressor gene CDKN2A. After successful chemotherapeutic treatment the patient experienced a relapse with a secondary ALL without complex karyotype but a deletion del(19)(p13). Unfortunately, the patient died after 17 months of the initial diagnosis.
    CONCLUSIONS: To the best of our knowledge, a comparable childhood ALL associated with such complex karyotype and deletion del(19)(p13) in secondary ALL was not previously reported. Thus, the complex karyotype with dicentrc dic(9;20;X) seems to indicate for a poor prognosis.
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  • DOI:
    文章类型: Case Reports
    Chromosomal aberrations play an important role in the incidence of myelodysplastic syndromes (MDS) and development to acute myeloid leukemia (AML). We report a case of a 62-year-old male patient diagnosed with MDS with excess blasts. The karyotype was 45, XY,+1,+1,-7,-10,-22,t(1;14) (q21;q32),t(1;17)(q21;p13),t(1;19)(q21;p13). The patient and his family refused treatment for financial reasons. After 2 months, the patient\'s MDS transformed into acute myeloid monocytic leukemia (AML-M5). This case of MDS with poor prognosis shows that patients with chromosomal numerical abnormality and balanced translocations should be treated early to prevent transition to AML. Further study of this case will reveal the molecular mechanism of MDS-to-AML transformation and identify new leukemic fusion genes.
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  • DOI:
    文章类型: Case Reports
    目标:弥漫性大B细胞淋巴瘤(DLBCL),NOS,占发达国家成人非霍奇金淋巴瘤的25-35%,发展中国家的比例更高;老年人容易患这种疾病。已经认识到三种常见的形态学变异,包括着丝粒,免疫母细胞,和间变性变体。然而,还有其他罕见的DLBCL形态变异,在诊断和治疗方面提出了挑战。
    方法:一名62岁的女性因之前有6个月的间歇性发热和白细胞增多病史而就医。骨髓(BM)抽吸显示AML具有急性单核细胞白血病样形态特征。免疫表型分析结果提示成熟B细胞淋巴瘤无明显亚型特征。淋巴结活检提示DLBCL为非生发中心B细胞亚型(n-GCB)。BM细胞的细胞遗传学分析显示46,XX,trp(1)(q21q32),del(7)(q32q36),t(9;14)(p13;q32)[4]/46,XX[16]核型。患者被诊断为EBV阳性DLBCL,NOS结合淋巴结活检,临床,细胞学,免疫表型,和细胞遗传学分析。
    结论:迄今为止,目前尚无病例报告有1例患者被诊断为DLBCL,其模拟急性单核细胞白血病并具有复杂核型.鉴于案件的稀有性,我们提出了这个案件,容易误诊,预后不良。该病例强调了实验室工作人员和血液学家对罕见形态变异的认识的重要性。
    OBJECTIVE: Diffuse Large B-Cell Lymphoma (DLBCL), NOS, constitutes 25-35% of adult non-Hodgkin lymphomas in developed countries, and a higher percentage in developing countries; older people are prone to the disease. Three frequent morphological variants have been recognized, including centroblastic, immunoblastic, and anaplastic variants. However, there are still other rare morphological variants of DLBCL, presenting challenge in diagnosis and treatment.
    METHODS: A 62-year-old woman sought medical attention with a previous 6-month history of intermittent fever and leukocytosis. Bone marrow (BM) aspiration presented AML with acute monocytic leukemia-like morphologic features. The results of the immunophenotypic analysis suggested mature B cell lymphoma without obvious subtype characteristics. Lymph node biopsy indicated DLBCL of non-germinal centre B-cell subtype (n-GCB). Cytogenetic analysis of the BM cells revealed a 46,XX, trp(1)(q21q32),del(7)(q32q36),t(9;14)(p13;q32) [4]/46,XX [16] karyotype. The patient was diagnosed with EBV-positive DLBCL, NOS based on the combination of lymph node biopsy, clinical, cytological, immunophenotypic, and cytogenetic analyses.
    CONCLUSIONS: To date, no case reports of a patient diagnosed with DLBCL mimicking acute monocytic leukemia with complex karyotype have been reported. We present the case given its rarity, easy misdiagnosis, and poor prognosis. The case highlights the importance of awareness about the rare morphological variant to laboratory staff and hematologists.
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