myeloid neoplasm with presenting with hepatosplenomegaly ... neopla… · aml including...
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Myeloid neoplasm with PCM1-JAK2presenting with hepatosplenomegaly
Case 376Magdalena Czader, MD, PhD
Indiana UniversityIndianapolis, IN
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Clinical history• 13-year-old Caucasian male with a history of ulcerative colitis
• Presented with progressive hepatosplenomegaly and underwent liver biopsy as a work-up for possible primary sclerosing cholangitis or autoimmune hepatitis
• CBC: WBC 13x109/L with eosinophilia (3.3x109/L)hemoglobin 11.2 g/dLMCV 77 fLRDW 17.3%platelet count of 187x109/L
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Liver biopsy
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Liver biopsy
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Liver biopsy
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Bone marrow biopsy
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Prominent eosinophilia
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Expanded erythroid islands
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Hemoglobin A CD117
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Loose megakaryocyte clusters
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Reticulin stain
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CD34
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Peripheral blood smear
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46,XY,t(8;9)(p22;p24)[21]/Nonclonal[2]/46,XY[2]
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Proposed diagnosis
Myeloid neoplasm with PCM1-JAK2
2016 WHO classification:Myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA, PDGFRB, or FGFR1, or with PCM1-JAK2
Provisional entity: Myeloid/lymphoid neoplasms with PCM1-JAK2
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PCM1
PCM1-JAK2
JAK2
JH2 PTK domain
JH2 PTK domain
Coiled-coil domains
Pericentriolar Material 1 (PCM1)• Localized in cytoplasmic granules-centriolar satellites
• Recruits proteins necessary for centrosome replication• Microtubule organization• Blocking with antibodies or siRNA leads to disorderly
centrosome organization
SH2
SH2
PCM1-JAK2 rearrangement
Dammermann et al. Dev Cell 2004Bousquet et al. Oncogene 2005Murati et al. Leukemia 2005
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JAK2 JAK2JAK2mutations
Decreased autoregulation
Hypersensitivity to growth factor
PV, PMF, ET
PCM1-JAK2
Increased oligo/dimerization
Growth factor independent
CEL, aCML, MDS/MPN-U,
AML, ALL
STAT5
STAT5
TRANSCRIPTION ACTIVATION
Protracted Aggressive
Adopted from Smith & Fan Human Pathol 2008
Other partner genes:ETV6, BCR,SSBP2, PAX5,SEC31A
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Diverse presentations of myeloid and lymphoid neoplasms with PCM1-JAK2
MPNPMF, PMF in
transformation, CEL
MDS/MPNaCML, MDS/MPN-U
Acute LeukemiasAML including
erythroleukemia, myeloid sarcoma, B and
T-ALL/LBL*Rare case of T cell lymphoma
Stewart et al. Am J Hematol 1990Reiter et al. Cancer Res 2005Murati et al. Leukemia 2005Patterer et al. Ann Hematol 2013Bain and Ahmad Br J Haematol 2014Song et al. Ann Lab Med 2016
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• 35 cases• 30 males• Median age 47 (range 12-75 years)
• CBC:• Variable leukocytosis: 11.8-435x109/L• Left shift• Frequent eosinophilia
Diverse presentations of myeloid and lymphoid neoplasms with PCM1-JAK2
Stewart et al. Am J Hematol 1990Reiter et al. Cancer Res 2005Murati et al. Leukemia 2005Patterer et al. Ann Hematol 2013Bain and Ahmad Br J Haematol 2014Song et al. Ann Lab Med 2016
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Common features of myeloid neoplasms with PCM1-JAK2
• Male predominance• Hepatosplenomegaly• Hypercellular bone marrow• Bone marrow fibrosis• Eosinophilia• Prominent erythropoiesis with left shift• Frequent transformation to acute leukemia
• Complete and partial responses to ruxolitinib (rare cases reported)
Stewart et al. Am J Hematol 1990 Bain and Ahmad Br J Haematol 2014Reiter et al. Cancer Res 2005 Lierman et al. Blood 2012Murati et al. Leukemia 2005 Rumi et al. JCO 2013Patterer et al. Ann Hematol 2013 Schwaab et al. Ann Hematol 2015
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Panel diagnosis
Myeloid/lymphoid neoplasm with PCM1-JAK2