HISTORY: 2010 isolated erythrocytosis and eosinophilia 1.3. JAK2(-). No splenomegaly. Due to COPD reative erythrocytosis was diagnosed and 2 erythrophareses were done. 2012 maculopapular rush on the legs (photo macro below). Leukocytosis 12, eosinophilia 1.6. Thrombocythopenia 63. Anemia. PDGFRA and Bcr-abl1 (-). AML molecs (-). Next 6 months: leucocytosis 12-19L, eosinophilia 1,6-3,9, anemia ir thromboiytopenia. Peripheral blasts 0,5-1%. Hepato-splenomegaly and peripheral lymphadenopathy evolves (axillary up to 2cm). New rush elements on the hands, back abdomen with central necrosis. Blood: leucocytosis 19, Eosinophilia 3.97. RBC 4,5. HB-111 g/l. PLT-63.
Episode 1 (2012 July):
A. Threpine biopsy: AML, M6+ SM (reactive?)+ CEL.
B. Skin biopsy (not included): Dermatitis, drug reaction possible.
Episode 2 (2012 December):
A. Threpine biopsy: AML, M6+ SM (reactive?)+ CEL.
B. Skin biopsy: T pseudolymphoma with epidermothropism (mycosis like)(in the clinical cotext- if isolated: mycosis fungoides would be possible).
C. Node biopsy: Myeloid sarcoma (M6)+ T LBL. FLOW (diluted): disgranulopoiesis + eosinophilia. Without blastemia.
MOLEC's (aspirate/diluted): PDGFRA/FIP1 and Bcr-Abl1, JAK2 (-). Karyotype XY normal.
CLINICS: treatment: 3 weeks with Imatinib 1000mg/day. Eosinophilia diminished from 3.6 iki 2.9. Hb and PLT stable. Eruptions in hand's skin in resolution.
Proposal: NOT VERIFIED/POSSIBLE PDGFRA/PDGFRB/FGFR1 asociated multiple tumors: Myeloid sarcoma (AML M6 in BM)+ CEL+ SM (reactive?) (BM)+ T lymphoblastic lymphoma (node).
T LBL+ AML (M6, myeloid Sa)+ CEL+ SM (reactive)