In One Case Of Bone Marrow Fibrosis For The Diagnosis Of Acute Myeloid Leukemia Ideas

Objective To analyse a case of myelofbrosisi(MF)transforming into acute myelogenous leukemia(AML)for the diagnose process and better knowing the disease how to happen, develop and turnover.Patient material The patient was a 45-year-old man who had a arthralgia in 2003 and was admitted to hospital on June 30th,2004.Physical examination:slight anemia,no jaundice,no petechia,no tumefaction with liver,spleen,lymph node and joint,normal with heart,lung and abdomen.His laboratory results are WBC 1.65×10~9/L,ANC 0.47×10~9/L,Ly%63.55%,Hb 76.9g/L,Pts 27×10~9/L.Bone marrow picture show hypoplasia:erythron 9%, granulocyte series 42%,lymphocyte 45%,no megakaryocyt.Rheumatisme series and rheumatoid series are negative.RC 0.006,NAP 64%,ESR 110mm/h.IgA,IgM and IgG are normal.Primary digosis is chronic aplastic anemia(CAA).After taking orally androgen,cyclosporin A and prednisone for three months,his hemogram recovered better than before:WBC increased from 1.65×10~9/L to normal,Hb increased from 76.9g/Lto 100g/L,Pts increased from 27×10~9/L to 160×10~9/L.After one year his anemia,nosebeed and fever were serious.His weight decreased by 10 kilogram.He was admitted to hospital again on March 29th,2005.Bone marrow biopsy of many times showed MF(+++),but PET showed pilosity osseous metastatic carcinoma? Pathological secaretion of his many proper positiones outside hospital:(1)Pathologiea report of Beijing 301 hospital:(tumour after peritoneum)a few round cell s diffuse infiltration in fibrou connective tissue;immunophenotype: CD3(-),CD20(-),CD43(++),MPO(++).He was probably diagnosed as myelogenous granular leukocyte leukemia.Pathologica report of preclinieal medicine BeijingUniversity:(tumor in pars iliaca)diffusing moderate size neoplastic cells infiltration.Immunophenotype(Beijing 307 hspital):LCA (+),VIM(+),CD68(+),NES(-),CGA(-);He was probably diagnosed asmyelocyte malignant tumor.(3 Pathologica report of Beijing friendship hospital:(left tumor in pars iliaca) punctura samples all are tumor tissue with heteromorphism,maturate and immature leukocytes; immunophanotype:LCA(+)/-,VIM(+),CD43(+),CD68(+),MPO(+)/(-),NES (-),CGA(-),CD20(-),CD3(-),CD5(-);diagnosis:immature myelogenous malignant tumor.Result The patient was trend to diagnosed as MF transforming into AML.Secdary myelofibrosis could not be confirmed:1.Primary disease was not rheumatism and MDS. Because rheumatisme series and rheumatoid series are negative except CRP,and bone marrow picture fail to dyshaematopoiesis.2.Primary disease was not CAA.Because it was not supported for CAA to explain quick ESR,increasing pain of bone and joint and MF(+++).3.Primary disease was not AML.(1)Because the natural course of disease is usually about half one year,and it will be shorter with MF.The patient had almost two years of the case history.(2)AMKL was not enough proof to diagnose without positive CD41,CD42,CD61 and PPO.Final diagnosis was proved to MF transforming into AML:1.It was in line with the national diagnostic code for IMF.(1)His bone marrow smear and biopsy showed MF(+++)which was according with the essential condition of IMF.(2)His anemia,hypersplenotrophy and hypoplasia bone marrow were according with secondary condition of IMF.2.It was according with the prognosis and turnover of IMF.A few of IMF can develop into acute leukemia.The pathological secaretiones in three Binjing hospital showed AML.Conclusion 1.Inquiring case history,fundamental physical examination and conventional laboratory examination are the base for diagnosing all disease which is supposed to be paid high attention during the preliminary diagnosis,progression of disease and developing follow-up.It is beneficial for clinic docters to cultivate and train basic skill.2.When abnomal symptom,sign and conventional laboratory examination are not explained by one disease,it is supposed to find out primary disease from many respects. The patient's pain of bone abnormal;quicker blood sedimentation and MF(+++)were not supported for CAA to explain.The patient primary disease was thought as malignant tumor which was confirmed by bone marrow biopsy,pathological secaretion,immunohistochemistry,PET etc. 3.MF should be considered from both primary and secondary view in clinic.The diagnosis of IMF must be in line with the essential conditions with excluding SMF and pay much more attention to differential diagnosis.