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January 1985

Coexistence of Myeloid Metaplasia With Myelofibrosis and Hairy-Cell Leukemia

Author Affiliations

From the Departments of Medical Oncology (Drs Subramanian, Gomez, and Han), Pathology (Dr Kim), Immunology (Dr Minowada), and Genetics and Endocrinology (Dr Sandberg), Roswell Park Memorial Institute, Buffalo. Dr Subramanian is now with the Veterans Administration Medical Center, Temple, Tex; Dr Minowada is now with the Department of Pathology, VA Medical Center, Hines, Ill.

Arch Intern Med. 1985;145(1):164-166. doi:10.1001/archinte.1985.00360010210040

• A 42-year-old man with severe pancytopenia and myelofibrosis underwent splenectomy seven months after onset of his symptoms; the leukocyte, platelet, and hematocrit levels became normal. Myeloid metaplasia was identified in the liver and spleen. Progressive lymphocytosis started eight months after splenectomy, and after 66 months a florid hairy-cell leukemia was diagnosed; the circulating cells were B type with μκ surface markers. Anemia and thrombocytopenia reappeared and were controlled initially with daily prednisone; chlorambucil was later added. At that time, the peripheral blood had more than 150 megaloblastoid-appearing normoblasts per 100 leukocytes. The PAS stain was positive in 95% to 100% of these cells; the B-cell surface markers were no longer identified. Further treatment failed to control the lymphoproliferative and myeloproliferative syndromes; the patient died 99 months after splenectomy. On autopsy, infiltration by hairy-cell leukemia cells and erythroid precursors was observed in the bone marrow, liver, lymph nodes, and other organs.

(Arch Intern Med 1985;145:164-166)