![A 63-year-old woman presented with a 2-month history of progressive dyspnea, weight loss, and a macular-papular rash over her back (panel A). Her medical history included breast cancer (treated 5 years ago with surgery and adjuvant chemotherapy) and chronic mild thrombocytopenia (baseline platelet count of 100 × 109/L). Her full blood count was normal, except for a platelet count of 76 × 109/L. Blood film examination appeared reactive. Chest X-ray and computed tomography (CT) scans of the chest/abdomen/pelvis were normal. The patient was discharged on antibiotics for a chest infection but was readmitted 1 month later with progressive dyspnea. A high-resolution CT chest scan now showed signs suspicious of lymphangitic spread of breast cancer. A skin biopsy was taken of her rash. It revealed blast-like cells (panels B and C; magnification ×10 and ×60, respectively; hematoxylin and eosin stain), which were negative for cytokeratins, CD34, CD56, CD117, and terminal deoxynucleotidyl transferase, but were positive for CD43, CD31, Bcl2, CD4, CD33, and myeloperoxidase (panel D; magnification ×20; myeloperoxidase stain), suggestive of cutaneous involvement of acute myelomonocytic leukemia. / The diagnosis of secondary (therapy-related) acute myeloid leukemia (AML) was confirmed on bone marrow biopsy. Cytogenetics showed an abnormal hypotetraploid karyotype: 88<4n>,XXXX,−1,−2,+8,−9,−10,−11,−14,−15,−17,+mar1x3[13]/46,XX[2]. The patient deteriorated and died 6 days later. Hypotetraploidy (or near tetraploidy) has not previously been reported in secondary AML, but it is a rare finding in primary AML and is associated with a poor prognosis.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/128/24/10.1182_blood-2016-08-732669/4/m_blood732669f1.jpeg?Expires=1734585469&Signature=LN5SH1ZeDRNeuNQsjDjpnd-jvrLLQvRvheW8ACFH-rsNDBTiTN5PfbTdd1ZVJOtl~~ryWEv5cw~XDb6wRHQ88JkjUDCy36MLOuNyogLqidJZIgUaDVqsQlELz8xZ1y4T2t8Oci2YWrJsgmgKp-kOKf47pxqPbDGyO~SyQXj51zH-FejH42JZFI9IM3LGclpfAP9E7kPGn-PL4TrCmOzEK5DuK0UYJa1ZusfduNTmHLf27-E0X5DyCriOAiH~Gap81A7dJ6g61UAjgiMYwZcNkmAbq8usNU34-kkxqOYczHozN6AhP86xErsGWoq8L2ZPSOk1dPD9ATDynlezhc51xQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 63-year-old woman presented with a 2-month history of progressive dyspnea, weight loss, and a macular-papular rash over her back (panel A). Her medical history included breast cancer (treated 5 years ago with surgery and adjuvant chemotherapy) and chronic mild thrombocytopenia (baseline platelet count of 100 × 109/L). Her full blood count was normal, except for a platelet count of 76 × 109/L. Blood film examination appeared reactive. Chest X-ray and computed tomography (CT) scans of the chest/abdomen/pelvis were normal. The patient was discharged on antibiotics for a chest infection but was readmitted 1 month later with progressive dyspnea. A high-resolution CT chest scan now showed signs suspicious of lymphangitic spread of breast cancer. A skin biopsy was taken of her rash. It revealed blast-like cells (panels B and C; magnification ×10 and ×60, respectively; hematoxylin and eosin stain), which were negative for cytokeratins, CD34, CD56, CD117, and terminal deoxynucleotidyl transferase, but were positive for CD43, CD31, Bcl2, CD4, CD33, and myeloperoxidase (panel D; magnification ×20; myeloperoxidase stain), suggestive of cutaneous involvement of acute myelomonocytic leukemia.
The diagnosis of secondary (therapy-related) acute myeloid leukemia (AML) was confirmed on bone marrow biopsy. Cytogenetics showed an abnormal hypotetraploid karyotype: 88<4n>,XXXX,−1,−2,+8,−9,−10,−11,−14,−15,−17,+mar1x3[13]/46,XX[2]. The patient deteriorated and died 6 days later. Hypotetraploidy (or near tetraploidy) has not previously been reported in secondary AML, but it is a rare finding in primary AML and is associated with a poor prognosis.
A 63-year-old woman presented with a 2-month history of progressive dyspnea, weight loss, and a macular-papular rash over her back (panel A). Her medical history included breast cancer (treated 5 years ago with surgery and adjuvant chemotherapy) and chronic mild thrombocytopenia (baseline platelet count of 100 × 109/L). Her full blood count was normal, except for a platelet count of 76 × 109/L. Blood film examination appeared reactive. Chest X-ray and computed tomography (CT) scans of the chest/abdomen/pelvis were normal. The patient was discharged on antibiotics for a chest infection but was readmitted 1 month later with progressive dyspnea. A high-resolution CT chest scan now showed signs suspicious of lymphangitic spread of breast cancer. A skin biopsy was taken of her rash. It revealed blast-like cells (panels B and C; magnification ×10 and ×60, respectively; hematoxylin and eosin stain), which were negative for cytokeratins, CD34, CD56, CD117, and terminal deoxynucleotidyl transferase, but were positive for CD43, CD31, Bcl2, CD4, CD33, and myeloperoxidase (panel D; magnification ×20; myeloperoxidase stain), suggestive of cutaneous involvement of acute myelomonocytic leukemia.
The diagnosis of secondary (therapy-related) acute myeloid leukemia (AML) was confirmed on bone marrow biopsy. Cytogenetics showed an abnormal hypotetraploid karyotype: 88<4n>,XXXX,−1,−2,+8,−9,−10,−11,−14,−15,−17,+mar1x3[13]/46,XX[2]. The patient deteriorated and died 6 days later. Hypotetraploidy (or near tetraploidy) has not previously been reported in secondary AML, but it is a rare finding in primary AML and is associated with a poor prognosis.
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