Letters to Editor
38.4 × 10 9/L. Investigations revealed urea 94.2 mg/dl, creatinine 2.2 mg/dl, uric acid 11.4 mg/dl (2.6‑7.2), calcium 7.2 mg/dl (8.2‑10.2 mg/dl), phosphorus 5.9 (2.5‑4.6 mg/dl). Liver function tests were normal. Blood and urine cultures were sterile. Naranjo ADR probability score (for determining whether an adverse reaction is actually due to the drug rather than the result of other factors) was nine suggesting definite association with bendamsutine.[1] A diagnosis of tumor lysis syndrome with non‑oliguric acute renal failure was made. He was treated with hyperhydration and single dose of rasburicase 1.5 mg. Four hours later uric acid dropped to 5.3 mg/dl. Next day creatinine came down to 1.1 mg/dl, urea to 57.8 mg/dl, and the following day urea dropped to 27.8, creatinine to 0.8, uric acid to 1.9 and remained low during subsequent days. Four weeks later he received 2 nd cycle of chemotherapy with bendamustine and rituximab. He tolerated chemotherapy well this time without any evidence of tumor lysis syndrome. Bendamustine with rituximab rgimen is generally considered safe and has been used in the treatment of advanced or relapsed CLL with an acceptable side effect profile.[2] Knauf et al. reported 1.2% incidence of tumor lysis without mention of any renal failure. [3] Another study reported only one patient who had preexisting renal dysfunction to develop TLS.[4] Hummel et al. reported a case of recurrent chemotherapy‑induced TLS with renal failure in one patient with CLL. [5] Our patient had high pre treatment WBC, multiple enlarged nodes, hepato‑splemegaly suggesting high tumor burden. The occurrence of tumor lysis in patients with CLL warrants a close monitoring for tumor lysis specially those presenting with high leukocyte counts.
Metaplastic carcinoma of the breast: A case report with review of literature
Sir, A 52 years old female presented with right breast lump for eight months. On clinical examination a 4 × 4 cm firm, mobile, non‑tender lump was identified in the inner‑upper quadrant of her right breast. The nipple was retracted and the overlying skin of the breast showed peau d’orange skin change. The underlying muscles and the chest wall were free. There was no significant axillary or cervical lymphadenopathy (T4bN0MX). The other breast was normal. A fine needle aspiration biopsy (FNAB) of the right breast mass was highly suggestive of Intracystic Papillary Carcinoma of breast. X‑ray of the chest, abdominal ultrasonography, whole‑body bone scan revealed no evidence of metastasis. Her hematological and biochemical parameters were normal. Subsequently she underwent a modified radical mastectomy (MRM). Gross examination of specimen revealed a growth 5 × 5 × 4 cm, Skin and deep resection margins were free, Largest of the thirteen Lymph nodes (level I and II) found, measured 2.8 × 1.8 cm [Figures 1 and 2]. Microscopic examination revealed invasive metaplastic carcinoma with a high grade spindle cell type, Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Naithani R, Bhat A, Bhasin A1 Division of Bone Marrow Transplantation and Hematology, 1Department of Medical Onclolgy, Nephrology, Max Hospital, Delhi, India Correspondence to: Dr. Rahul Naithani, E‑mail: [email protected]
References 1. 2.
3.
4.
5.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions.Clin Pharmacol Ther 1981;30:239‑45. Fischer K, Cramer P, Busch R, Stilgenbauer S, Bahlo J, Schweighofer CD, et al. Bendamustine combined with rituximab in patients with relapsed and/or refractory chronic lymphocytic leukemia: A multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol 2011;29:3559‑66. Knauf WU, Lissichkov T, Aldaoud A, Liberati A, Loscertales J, Herbrecht R, et al. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 2009;27:4378‑84. Bergmann MA, Goebeler ME, Herold M, Emmerich B, Wilhelm M, Ruelfs C, et al. Efficacy of bendamustine in patients with relapsed or refractory chronic lymphocytic leukemia: Results of a phase I/II study of the German CLL study group. Haematologica 2005;90:1357‑64. Hummel M, Buchheidt D, Reiter S, Bergmann J. Recurrent chemotherapy‑induced tumor lysis syndrome (TLS) with renal failure in a patient with chronic lymphocytic leukemia – successful treatment and prevention of TLS with low‑dose rasburicase. Eur J Haematol 2005;75:518‑21. Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146740 PMID: *****
Lymphovascular invasion or perineural invasion were absent and no metastatic deposits were seen in all the thirteen lymph nodes i.e., pt2N0 [Figures 3-5]. On immunohistochemial examination the tumor cells were positive for pancytokeratin, epithelial membrane antigen and vimentin and negative for ER (Estrogen receptors) and PR (progesterone receptors) and cerB2 oncoprotein. The patient received, six cycles of FEC (Fluorouracil, Epirubicin, and Cyclophosphamide) combination chemotherapy and chest wall radiation therapy (TD 50 Gy, 25 fractions). She was in good condition at her latest follow up, 8 months post‑operatively. The reported incidence of Metaplastic Breast Carcinoma (MBC) is 0.2% of all breast cancers.[1] MBC is generally considered to be high grade, with clinical presentations mimicking to those of infiltrating duct carcinoma (IDC), although it may rarely present as inflammatory carcinoma. [2] Metaplastic carcinoma is a rare tumor of breast consisting of intraductal or invasive carcinoma contigious or subtly merged with a highly cellular, mitotically active pleomorphic spindle cell stroma.[2] In MBC, carcinomas show extensive metaplastic change to squamous cells, spindle cells or heterologous mesenchymal elements. In the breast, the most popular theory regarding the histogenesis of the metaplastic components is through transformation of myoepitheleal cells.[3] In most tumors, areas of infiltrating duct carcinomas are present 381
Letters to Editor
Figure 1: Metaplastic carcinoma breast, (H and E, ×10)
Figure 2: Metaplastic carcinoma breast, (H and E, ×40)
Figure 3: Immunostaining of panctyokeratin, ×40
Figure 4: Immunostaining of epithelial membrane antigen, ×20
Figure 5: Immunostaining of vimentin, ×40
with transition to metaplastic elements. The sarcoma like component may resemble malignant fibrous histiocytoma, chondrosarcomas, osteosarcomas, rhabdomyosarcomas or a combination of these.[3] The diagnosis of epithelial – only 382
subtype (adenosquamous or pure squmous cell carcinoma) can be based only on morphological assessment, but diagnosing the biphasic and monophasic types of metaplastic carcinoma requires the use of immunohistochemistry. Cytokeratin (AE1/AE3) remains the most widely used and the most sensitive marker, together with epithelial membrane antigen and vimentin, for defining the metaplastic spindle cells, particularly the monophasic subtype. As in the present case, most metaplastic carcinomas are negative for hormone receptors (oestrogen, progesterone) and expression of cerbB2 oncoprotein, in contrast with the high grade (grade‑3) breast carcinomas where the cerbB2 positivity rate is about 35%. The treatment option for this tumor remains unclear. The absence of hormone receptors and cerbB2 oncoprotein expression limit oncological treatment options. Patients with metaplastic carcinomas tend to have poor outcomes with a high risk of recurrence after surgery. Aggressive presentation of this case recommended radical local and adjuvant treatment by radical mastectomy followed by radiation and chemotherapy, though the need for chemotherapy is unknown because of the absence of large series of randomized or observational data.[4] Sayed et al.[5] state that MBC is Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Letters to Editor
aggressive with a poor outcome., Tumor size has been postulated as passively the only relatively useful prognostic indicator and the mesenchymal elements involved, may also have some importance in prognosis. Acknowledgment Authors acknowledge the cooperation of patient’s husband for supplying the reports etc., for our study.
2. 3. 4. 5.
Roy C, Choudhury KB, Saha A, Bag S Department of Radiotherapy, Institute of Post Graduate Medical Education and Research and S.S.K.M. Hospital, 244, A.J.C. Bose Road, Kolkata, West Bengal, India
carcinoma of breast (carcinosarcoma variant): A case report. Indian J Pathol Microbiol 2007;50:396‑8. Gogas J, Kouskos E, Markopoul C, Mantas D. Carcinosarcoma of the breast; report of two cases. Eur J Gynaecol Oncol 2003;24:93‑5. Kurian KM, AL‑Nafussi A. Sarcomatoid/metaplastic carcinoma of the breast: A clinicopathological syudy of 12 cases. Histopathology 2002;40:58‑64. Ridolfi RL, Jamehdor MR, Arber JM. HER‑2/new testing in breast carcinomas: A study on 942 cases. Breast Cancer Res Treat 1995;35:283‑91. Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast, clinical presentation, treatment results and prognosic factors. Acta Oncol 2006;45:188‑95. Access this article online Quick Response Code:
Correspondence to: Dr. Animesh Saha, E-mail: [email protected]
DOI: 10.4103/0019-509X.146745
References 1.
Website: www.indianjcancer.com
PMID: *****
Patrikar A, Maimoon S, Mahore S, Akhtar MA, Wilkinson A. Metaplastic
Isodicentric Philadelphia [idic(Ph)] chromosome in a case of CML at chronic phase
Sir, Chronic myelogenous leukemia (CML) is characterized by the translocation t(9;22)(q34;q11.2) i.e. Ph chromosome molecularly BCR/ABL fusion gene on the Ph chromosome. The isodicentricPh[idic(Ph)] chromosome is a rare chromosome aberration formed by the fusion of the two identical Ph chromosomes with retaining their centromeres. We describe the first case of CML in chronic phase with an idic(Ph) chromosome. A 32-year-old man was admitted to our hospital because of weakness and joint pains. He had no past history of antecedent hematological disorder. Physical examination of the patient revealed no alterations of the palpable lymph nodes and moderate hepatosplenomegaly and liver was enlarged 2 cm, the spleen 2 cm below the coastal margin. He had inconsistent bowel and bladder. Peripheral blood showed hemoglobin 11.7 g/dl, platelets 30 × 109/L and white blood cells (WBC) 2.8 × 109. Bone marrow aspiration showed 2% blast cells, erythroid series relatively reduced and showed delayed hemoglobinisation. Myeloid series showed marked hyperplasia. Megakaryocytes were increased with both mature and immature forms. The patient was diagnosed as CML at chronic phase and he was started on 400 mg imatinib mesylate therapy which was increased to 800 mg/day soon after initiating the therapy. Chromosomal analysis at the time of diagnosis showed 46, XY, idicder(22) t(9;22)(q34;q11) [20]/46, XY [5] [Figure 1a and b]. The idic(Ph) chromosome had two centromeres and supposed to be generated by the fusion of two Ph chromosomes at the terminal regions of their long arms. Then the idic(Ph) chromosome was described as; 22pter→cen→ 22q11::9q34→9qter::9qter→9q34::22q11 →cen→ 22pter. Fluorescence in situ hybridization (FISH) with BCR/ABL dual fusion probe initially on metaphase spreads showed one larger BCR/ABL on idic(Ph) chromosome in all 10 metaphases examined [Figure 1c]. The FISH on interphase cells revealed Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
a
c
b
d
Figure 1: (a) GTG‑metaphase showing der (9) and idic(Ph) chromosomes. (b) Partial karyotype showing idic(Ph) chromosome break points. (c) FISH on metaphase showing large BCR‑ABL fusion on idic(Ph) chromosome. (d) Interphase cell showing BCR‑ABL fusion on isolated signal, which is idic(Ph)
BCR/ABL large signal in 90% of 200 interphase cells analyzed [Figure 1d]. The patient was followed up for two years an at six months intervals. The blood counts were high and cytogenetic investigation showed idic(Ph) positive. Hence, the patient was resistant to the therapy. The idic(Ph) chromosome was first reported in 1973 by Whang‑Peng et al.[1] in late stage of disease in five patients who were initially classified as Ph positive. In our case idic (Ph) chromosome was detected at the time of diagnosis and to the best of our knowledge, this is the first case of CML patient with idic(Ph) at chronic phase. Overall 11 cases with idic(Ph) have been reported but all cases 383
Copyright of Indian Journal of Cancer is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
38.4 × 10 9/L. Investigations revealed urea 94.2 mg/dl, creatinine 2.2 mg/dl, uric acid 11.4 mg/dl (2.6‑7.2), calcium 7.2 mg/dl (8.2‑10.2 mg/dl), phosphorus 5.9 (2.5‑4.6 mg/dl). Liver function tests were normal. Blood and urine cultures were sterile. Naranjo ADR probability score (for determining whether an adverse reaction is actually due to the drug rather than the result of other factors) was nine suggesting definite association with bendamsutine.[1] A diagnosis of tumor lysis syndrome with non‑oliguric acute renal failure was made. He was treated with hyperhydration and single dose of rasburicase 1.5 mg. Four hours later uric acid dropped to 5.3 mg/dl. Next day creatinine came down to 1.1 mg/dl, urea to 57.8 mg/dl, and the following day urea dropped to 27.8, creatinine to 0.8, uric acid to 1.9 and remained low during subsequent days. Four weeks later he received 2 nd cycle of chemotherapy with bendamustine and rituximab. He tolerated chemotherapy well this time without any evidence of tumor lysis syndrome. Bendamustine with rituximab rgimen is generally considered safe and has been used in the treatment of advanced or relapsed CLL with an acceptable side effect profile.[2] Knauf et al. reported 1.2% incidence of tumor lysis without mention of any renal failure. [3] Another study reported only one patient who had preexisting renal dysfunction to develop TLS.[4] Hummel et al. reported a case of recurrent chemotherapy‑induced TLS with renal failure in one patient with CLL. [5] Our patient had high pre treatment WBC, multiple enlarged nodes, hepato‑splemegaly suggesting high tumor burden. The occurrence of tumor lysis in patients with CLL warrants a close monitoring for tumor lysis specially those presenting with high leukocyte counts.
Metaplastic carcinoma of the breast: A case report with review of literature
Sir, A 52 years old female presented with right breast lump for eight months. On clinical examination a 4 × 4 cm firm, mobile, non‑tender lump was identified in the inner‑upper quadrant of her right breast. The nipple was retracted and the overlying skin of the breast showed peau d’orange skin change. The underlying muscles and the chest wall were free. There was no significant axillary or cervical lymphadenopathy (T4bN0MX). The other breast was normal. A fine needle aspiration biopsy (FNAB) of the right breast mass was highly suggestive of Intracystic Papillary Carcinoma of breast. X‑ray of the chest, abdominal ultrasonography, whole‑body bone scan revealed no evidence of metastasis. Her hematological and biochemical parameters were normal. Subsequently she underwent a modified radical mastectomy (MRM). Gross examination of specimen revealed a growth 5 × 5 × 4 cm, Skin and deep resection margins were free, Largest of the thirteen Lymph nodes (level I and II) found, measured 2.8 × 1.8 cm [Figures 1 and 2]. Microscopic examination revealed invasive metaplastic carcinoma with a high grade spindle cell type, Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Naithani R, Bhat A, Bhasin A1 Division of Bone Marrow Transplantation and Hematology, 1Department of Medical Onclolgy, Nephrology, Max Hospital, Delhi, India Correspondence to: Dr. Rahul Naithani, E‑mail: [email protected]
References 1. 2.
3.
4.
5.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions.Clin Pharmacol Ther 1981;30:239‑45. Fischer K, Cramer P, Busch R, Stilgenbauer S, Bahlo J, Schweighofer CD, et al. Bendamustine combined with rituximab in patients with relapsed and/or refractory chronic lymphocytic leukemia: A multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol 2011;29:3559‑66. Knauf WU, Lissichkov T, Aldaoud A, Liberati A, Loscertales J, Herbrecht R, et al. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 2009;27:4378‑84. Bergmann MA, Goebeler ME, Herold M, Emmerich B, Wilhelm M, Ruelfs C, et al. Efficacy of bendamustine in patients with relapsed or refractory chronic lymphocytic leukemia: Results of a phase I/II study of the German CLL study group. Haematologica 2005;90:1357‑64. Hummel M, Buchheidt D, Reiter S, Bergmann J. Recurrent chemotherapy‑induced tumor lysis syndrome (TLS) with renal failure in a patient with chronic lymphocytic leukemia – successful treatment and prevention of TLS with low‑dose rasburicase. Eur J Haematol 2005;75:518‑21. Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146740 PMID: *****
Lymphovascular invasion or perineural invasion were absent and no metastatic deposits were seen in all the thirteen lymph nodes i.e., pt2N0 [Figures 3-5]. On immunohistochemial examination the tumor cells were positive for pancytokeratin, epithelial membrane antigen and vimentin and negative for ER (Estrogen receptors) and PR (progesterone receptors) and cerB2 oncoprotein. The patient received, six cycles of FEC (Fluorouracil, Epirubicin, and Cyclophosphamide) combination chemotherapy and chest wall radiation therapy (TD 50 Gy, 25 fractions). She was in good condition at her latest follow up, 8 months post‑operatively. The reported incidence of Metaplastic Breast Carcinoma (MBC) is 0.2% of all breast cancers.[1] MBC is generally considered to be high grade, with clinical presentations mimicking to those of infiltrating duct carcinoma (IDC), although it may rarely present as inflammatory carcinoma. [2] Metaplastic carcinoma is a rare tumor of breast consisting of intraductal or invasive carcinoma contigious or subtly merged with a highly cellular, mitotically active pleomorphic spindle cell stroma.[2] In MBC, carcinomas show extensive metaplastic change to squamous cells, spindle cells or heterologous mesenchymal elements. In the breast, the most popular theory regarding the histogenesis of the metaplastic components is through transformation of myoepitheleal cells.[3] In most tumors, areas of infiltrating duct carcinomas are present 381
Letters to Editor
Figure 1: Metaplastic carcinoma breast, (H and E, ×10)
Figure 2: Metaplastic carcinoma breast, (H and E, ×40)
Figure 3: Immunostaining of panctyokeratin, ×40
Figure 4: Immunostaining of epithelial membrane antigen, ×20
Figure 5: Immunostaining of vimentin, ×40
with transition to metaplastic elements. The sarcoma like component may resemble malignant fibrous histiocytoma, chondrosarcomas, osteosarcomas, rhabdomyosarcomas or a combination of these.[3] The diagnosis of epithelial – only 382
subtype (adenosquamous or pure squmous cell carcinoma) can be based only on morphological assessment, but diagnosing the biphasic and monophasic types of metaplastic carcinoma requires the use of immunohistochemistry. Cytokeratin (AE1/AE3) remains the most widely used and the most sensitive marker, together with epithelial membrane antigen and vimentin, for defining the metaplastic spindle cells, particularly the monophasic subtype. As in the present case, most metaplastic carcinomas are negative for hormone receptors (oestrogen, progesterone) and expression of cerbB2 oncoprotein, in contrast with the high grade (grade‑3) breast carcinomas where the cerbB2 positivity rate is about 35%. The treatment option for this tumor remains unclear. The absence of hormone receptors and cerbB2 oncoprotein expression limit oncological treatment options. Patients with metaplastic carcinomas tend to have poor outcomes with a high risk of recurrence after surgery. Aggressive presentation of this case recommended radical local and adjuvant treatment by radical mastectomy followed by radiation and chemotherapy, though the need for chemotherapy is unknown because of the absence of large series of randomized or observational data.[4] Sayed et al.[5] state that MBC is Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
Letters to Editor
aggressive with a poor outcome., Tumor size has been postulated as passively the only relatively useful prognostic indicator and the mesenchymal elements involved, may also have some importance in prognosis. Acknowledgment Authors acknowledge the cooperation of patient’s husband for supplying the reports etc., for our study.
2. 3. 4. 5.
Roy C, Choudhury KB, Saha A, Bag S Department of Radiotherapy, Institute of Post Graduate Medical Education and Research and S.S.K.M. Hospital, 244, A.J.C. Bose Road, Kolkata, West Bengal, India
carcinoma of breast (carcinosarcoma variant): A case report. Indian J Pathol Microbiol 2007;50:396‑8. Gogas J, Kouskos E, Markopoul C, Mantas D. Carcinosarcoma of the breast; report of two cases. Eur J Gynaecol Oncol 2003;24:93‑5. Kurian KM, AL‑Nafussi A. Sarcomatoid/metaplastic carcinoma of the breast: A clinicopathological syudy of 12 cases. Histopathology 2002;40:58‑64. Ridolfi RL, Jamehdor MR, Arber JM. HER‑2/new testing in breast carcinomas: A study on 942 cases. Breast Cancer Res Treat 1995;35:283‑91. Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast, clinical presentation, treatment results and prognosic factors. Acta Oncol 2006;45:188‑95. Access this article online Quick Response Code:
Correspondence to: Dr. Animesh Saha, E-mail: [email protected]
DOI: 10.4103/0019-509X.146745
References 1.
Website: www.indianjcancer.com
PMID: *****
Patrikar A, Maimoon S, Mahore S, Akhtar MA, Wilkinson A. Metaplastic
Isodicentric Philadelphia [idic(Ph)] chromosome in a case of CML at chronic phase
Sir, Chronic myelogenous leukemia (CML) is characterized by the translocation t(9;22)(q34;q11.2) i.e. Ph chromosome molecularly BCR/ABL fusion gene on the Ph chromosome. The isodicentricPh[idic(Ph)] chromosome is a rare chromosome aberration formed by the fusion of the two identical Ph chromosomes with retaining their centromeres. We describe the first case of CML in chronic phase with an idic(Ph) chromosome. A 32-year-old man was admitted to our hospital because of weakness and joint pains. He had no past history of antecedent hematological disorder. Physical examination of the patient revealed no alterations of the palpable lymph nodes and moderate hepatosplenomegaly and liver was enlarged 2 cm, the spleen 2 cm below the coastal margin. He had inconsistent bowel and bladder. Peripheral blood showed hemoglobin 11.7 g/dl, platelets 30 × 109/L and white blood cells (WBC) 2.8 × 109. Bone marrow aspiration showed 2% blast cells, erythroid series relatively reduced and showed delayed hemoglobinisation. Myeloid series showed marked hyperplasia. Megakaryocytes were increased with both mature and immature forms. The patient was diagnosed as CML at chronic phase and he was started on 400 mg imatinib mesylate therapy which was increased to 800 mg/day soon after initiating the therapy. Chromosomal analysis at the time of diagnosis showed 46, XY, idicder(22) t(9;22)(q34;q11) [20]/46, XY [5] [Figure 1a and b]. The idic(Ph) chromosome had two centromeres and supposed to be generated by the fusion of two Ph chromosomes at the terminal regions of their long arms. Then the idic(Ph) chromosome was described as; 22pter→cen→ 22q11::9q34→9qter::9qter→9q34::22q11 →cen→ 22pter. Fluorescence in situ hybridization (FISH) with BCR/ABL dual fusion probe initially on metaphase spreads showed one larger BCR/ABL on idic(Ph) chromosome in all 10 metaphases examined [Figure 1c]. The FISH on interphase cells revealed Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3
a
c
b
d
Figure 1: (a) GTG‑metaphase showing der (9) and idic(Ph) chromosomes. (b) Partial karyotype showing idic(Ph) chromosome break points. (c) FISH on metaphase showing large BCR‑ABL fusion on idic(Ph) chromosome. (d) Interphase cell showing BCR‑ABL fusion on isolated signal, which is idic(Ph)
BCR/ABL large signal in 90% of 200 interphase cells analyzed [Figure 1d]. The patient was followed up for two years an at six months intervals. The blood counts were high and cytogenetic investigation showed idic(Ph) positive. Hence, the patient was resistant to the therapy. The idic(Ph) chromosome was first reported in 1973 by Whang‑Peng et al.[1] in late stage of disease in five patients who were initially classified as Ph positive. In our case idic (Ph) chromosome was detected at the time of diagnosis and to the best of our knowledge, this is the first case of CML patient with idic(Ph) at chronic phase. Overall 11 cases with idic(Ph) have been reported but all cases 383
Copyright of Indian Journal of Cancer is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
