A 50-year-old man had chronic myelogenous leukemia and entered a blast crisis that was both morphologically and histochemically lymphoid. The blasts contained terminal deoxyribonucleotidyl transferase and expressed lymphoblastic leukemia-associated antigen. He rapidly entered remission with vincristine sulfate and prednisone therapy. Nevertheless, his blasts displayed a marker generally considered unique to myeloid cells: they selectively bound the granulocyte chemotaxin N-formyl-Met-Leu-Phe. In addition, some cells contained granules resembling those of basophils or mast cells. Such mixed myeloid-lymphoid features in chronic myelogenous leukemia blast cells may reflect malignant transformation of a stem cell capable of both myeloid and lymphoid differentiation, or they may reflect the dedifferentiation as a feature of malignant change.
Skubitz KM, Craddock PR, Weisdorf DJ, et al. Chronic Myelogenous Leukemia: Development of Blast Crisis With Both Lymphoid and Myeloid Features. JAMA. 1983;250(21):2957–2960. doi:10.1001/jama.1983.03340210055025
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