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A 1 9-year-old male patien t who is in rem ission after receivi ng LJ cycles of BEP chemo-therapy for primary mediastinal yolk sac germ cel l tumor presen ts with fatigue 3 mon ths after his last cycle. Laboratory evaluation shows leukocyte count of LJ3.500/JLL. hemoglobin 7.6 g/dl. and platelet count 7.000/JLL. The peripheral blood smear is shown below. Flow cytometry of the peripheral blood cells express CD 1 3 . CD3 3. CDLJ 1. and CD6 1 .
What is the most likely diagnosis?
- Therapy-related acute lymphoblastic leukemia
- Therapy-related acute myeloid leukemia
- Acute megakaryoblastic leukemia
- Therapy-related myelodysplastic syndrome evolving to acute leukemia
Medicine
C. The blood smear shows large cells with fine chromatin, a high nuclear-cytoplasmic ratio, and cytoplasmic vacuoles and blebs; in addition, giant, hypogranular platelets are seen. Such blood findings in concert with the flow cytometry immunophenotype is characteristic of acute megakaryo-blastic leukemia. Patients with primary nonseminomatous germ cell tumors, especially with a yolk sac component, have an increased incidence of hematologic malignancies, including acute leukemia and systemic mastocytosis, and acute megakaryoblastic leukemia is one of the most prevalent AML sub- types reported. The interval between the diagnosis of acute leukemia and germ cell tumor of 3 months contrasts with the average time of 24 to 60 months for therapy-related acute leukemia (! Natl Cancer Inst. 2000;92(1):54).
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