Imatinib mesylate-induced acute hepatotoxicity.

INTRODUCTION: Imatinib is a first-line selective tyrosine kinase inhibitor used for the treatment of chronic myeloid leukemia. Although imatinib-induced hepatotoxicity may aggravate the patient's clinical condition and alter the treatment plan, the mechanism of imatinib-induced hepatotoxicity has rarely been investigated. CASE REPORT: We report a 51-year-old man, suffering from acute toxic hepatitis after 5 months of imatinib treatment for chronic myeloid leukemia. MANAGEMENT AND OUTCOME: The outcome was favorable after discontinuation of treatment with normalization of biological liver function after 12 weeks. The treatment was switched to nilotinib without any incidents. DISCUSSION: Regular liver function test monitoring is recommended during imatinib treatment. In fact of acute hepatic toxicity, treatment with imatinib should be stopped in the case of cytolysis more than five times the upper limit of normal.

Primary plasma cell leukemia: what role does flow cytometry play? / La leucémie à plasmocytes primitive : quelle place pour la cytométrie en flux ?

Primary plasma leukemia is defined by the presence of more than 20% plasma cells in the peripheral blood or number of circulating plasma cells greater than 2G/L. It has points in common with multiple myeloma and has certain characteristics, in particular its aggressiveness and poor prognosis. Through 02 cases diagnosed in the flow cytometry laboratory, the authors present the clinical, cytological and especially immunophenotypic features of this disease, with the emphasis on the role of flow cytometry in the diagnosis.

La leucémie à plasmocytes primitive, observée de novo, est définie par la présence de plus de 20 % de plasmocytes de la formule leucocytaire ou un nombre de plasmocytes circulants supérieur à 2 G/L. Elle a des points communs avec le myélome multiple et possède certaines caractéristiques, en particulier son évolution très rapide et son mauvais pronostic. A travers 02 cas diagnostiqués à l'unité de cytomètrie en flux du laboratoire d'hémo-biologie, les auteurs présentent les particularités cliniques, cytologiques et notamment immunophénotypiques de cette affection en mettant l'accent sur la place de la cytométrie en flux dans le diagnostic.

Blastic plasmacytoid dendritic cell neoplasm: a diagnosis not to be missed, about three case reports.

INTRODUCTION: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a proliferation of plasmacytoid cell precursors. It is a rare and difficult-to-diagnose hematological malignancy with a poor outcome. CASE PRESENTATION: We report three cases of BPDCN diagnosed in patients of different nationalities (Tunisian, Algerian and Libyan) and varying ages (eight, 65 and 74 years old). Cutaneous involvement was present in all three cases. Cytology was inconclusive in the first case, in favor of acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) in the second and third case respectively. The diagnosis was retained by flow cytometry, highlighting the Cluster of Differentiation (CD) 4 + CD56 + phenotype of the blast population. CONCLUSION: These observations illustrate diagnosis challenges, the importance of biological/clinical confrontation in order not to misdiagnose this entity. Flow cytometry is an essential diagnostic tool.

Aberrant expression of CD5 in a case of B acute lymphoblastic leukemia positive Philadelphia chromosome.

INTRODUCTION: B acute lymphoblastic leukaemia (B-ALL) is a proliferation of hematopoietic precursor cells characterized by the expression of various B-cell antigens. Expression of T cell antigens has rarely been reported in B-ALL. We report the second case CD5+ (Cluster of differentiation 5) B-ALL associated with Philadelphia chromosome (Phi+). OBSERVATION: A 38-year old male presented with anorexia and generalized weakness for the last ten days. Hemogram revealed bicytopenia and hyperleukocytosis made of 93% difficult to classify cells. A diagnosis of diffuse large B-cell lymphoma was suspected. An immunophenotyping on peripheral blood was performed. The panel for B- cell lineage chronic lymphoproliferative disorders (B-CLPD) was used. The dim expression of CD45 and the lack of surface immunoglobuline helped to exclude a CD5 expressing mature B cell neoplasm. Then, the diagnosis of ALL was confirmed by ALL panels. Karyotype showed a Phi+. Thus, a diagnosis of B-ALL with aberrant expression of CD5 and Phi+ was established. The patient received chemotherapy according to the modified group for research on adult acute lymphoblastic leukemia philadelphia positive 2005 protocol (GRAAPH 2005). A complete remission at the end of induction was obtained. The patient received consolidation and then, hematopoietic stem cell transplantation. The patient is in complete hematological remission till the date of submission of this report. CONCLUSION: Aberrant expression of CD5 associated with Phi+ has rarely been reported in B cell lineage ALL and having a poor prognosis. Pathologists and clinicians should be aware of this entity to avoid confusion with other tumors.

Isolated optic nerve infiltration as a site of relapse of acute lymphoblastic leukemia.

Optic nerve infiltration is relatively rare in acute lymphoblastic leukemia. We present a case of a -53 year-old-man who was diagnosed with T- acute lymphoblastic leukemia (ALL). The patient was treated with ALL national protocol and the central nervous system (CNS) prophylactic management. On treatment, the patient presented with sudden severe vision deterioration of both eyes. Fundoscopic examination of the eye and magnetic resonance imaging of the orbits were in favor of an infiltration of the optical nerve. An isolated extramedullary relapse of the optical nerve was retained. The patient was treated with salvage chemotherapy systematic and intrathecal. Waiting forthe beginning of radiotherapy, the patient presented a bone marrow relapse. He died of a severe hemorrhagic syndrome. Conclusion: Optic nerve leukemic infiltration has a severe prognosis. Ophthalmic assessment is essential in patients with ALL in order to diagnose an early ocular involvement and the patient's vision can be preserved if treatment is initiated promptly.