Pathology – Research and Practice 211 (2015) 341–343
Contents lists available at ScienceDirect
Pathology – Research and Practice journal homepage: www.elsevier.com/locate/prp
Teaching case
Neutrophilic progression in a case of polycytemia vera mimicking chronic neutrophilic leukemia: Clinical and molecular characterization Roberto Castelli a,∗ , Massimo Cugno a , Umberto Gianelli c , Alessandro Pancrazzi b , Alessandro Maria Vannucchi b a Department of Medicine and Medical Specialities, Ca’ Granda Foundation IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy and Department of Clinical Sciences and Community Health, University of Milan, Via F. Sforza, 20122 Milan, Italy b Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Largo Brambilla 3, 50134 Florence, Italy c Pathology Unit, Department of Pathophysiology and Transplantation, University of Milan School of Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
a r t i c l e
i n f o
Article history: Received 3 May 2014 Received in revised form 2 October 2014 Accepted 13 October 2014 Keywords: Myeloproliferative neoplasms Polycythemia vera Chronic neutrophilic leukemia like-evolution Mutational analysis of the gene encoding colony-stimulating factor 3 receptor
a b s t r a c t Background: In a small subset of polycytemia vera (PV), neutrophilia not secondary to reactive conditions or treatment can develop and persist. Clinical significance and morphogenetic alterations associated with this uncommon phenomenon are not well defined. Case report: An 81-year-old Caucasian woman, affected by polycytemia vera lasting 17 years, presented in March 2012 with hyperleukocytosis, absolute neutrophilia, and thrombocytosis despite hydroxyurea treatment. All other laboratory parameters were normal, except for an increased neutrophil alkaline phosphatase and lactate dehydrogenase. Reactive neutrophilia due to infection or neoplasia have been ruled out by a total body computerized tomography scan, and by low levels of C reactive protein. Re-evaluation of bone marrow showed hypercellular smears with expansion of granulopoiesis while immature granulocytes were
Contents lists available at ScienceDirect
Pathology – Research and Practice journal homepage: www.elsevier.com/locate/prp
Teaching case
Neutrophilic progression in a case of polycytemia vera mimicking chronic neutrophilic leukemia: Clinical and molecular characterization Roberto Castelli a,∗ , Massimo Cugno a , Umberto Gianelli c , Alessandro Pancrazzi b , Alessandro Maria Vannucchi b a Department of Medicine and Medical Specialities, Ca’ Granda Foundation IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy and Department of Clinical Sciences and Community Health, University of Milan, Via F. Sforza, 20122 Milan, Italy b Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Largo Brambilla 3, 50134 Florence, Italy c Pathology Unit, Department of Pathophysiology and Transplantation, University of Milan School of Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
a r t i c l e
i n f o
Article history: Received 3 May 2014 Received in revised form 2 October 2014 Accepted 13 October 2014 Keywords: Myeloproliferative neoplasms Polycythemia vera Chronic neutrophilic leukemia like-evolution Mutational analysis of the gene encoding colony-stimulating factor 3 receptor
a b s t r a c t Background: In a small subset of polycytemia vera (PV), neutrophilia not secondary to reactive conditions or treatment can develop and persist. Clinical significance and morphogenetic alterations associated with this uncommon phenomenon are not well defined. Case report: An 81-year-old Caucasian woman, affected by polycytemia vera lasting 17 years, presented in March 2012 with hyperleukocytosis, absolute neutrophilia, and thrombocytosis despite hydroxyurea treatment. All other laboratory parameters were normal, except for an increased neutrophil alkaline phosphatase and lactate dehydrogenase. Reactive neutrophilia due to infection or neoplasia have been ruled out by a total body computerized tomography scan, and by low levels of C reactive protein. Re-evaluation of bone marrow showed hypercellular smears with expansion of granulopoiesis while immature granulocytes were
