Lösemi mi, Hematogon mu? (Olgu Sunumu)

Öz

Hematogonlar kemik iliğinin rejenerasyonu sırasında görülebilen B lenfosit kökenli immatür hücrelerdir. Bunlar bazofilik, dar sitoplazmalı, nükleus stoplazma oranı büyük, homojen kromatine sahip, bazen nükleolus içeren ancak granül ihtiva etmeyen hücrelerdir. Morfolojik olarak akut lenfoblastik lösemi veya lenfoblastik lenfomada görülen blastlara benzemelerinden dolayı, sayılarının arttığı durumlarda tanısal problemlere neden olurlar. İnfantlarda nedeni bilinmeyen viral enfeksiyonlar, yüksek doz kemoterapi sonrasında kemik iliğinde artmış oranda görüldükleri bildirilmiştir. Uzamış sarılık nedeni ile hastanemize başvuran ve lenfositoz nedeni ile izleme alınan üç aylık erkek hasta, klinik ve hematolojik değerleri lösemiyi çağrıştırsa da, yenidoğanlarda ve infantlarda lösemi tanısı konurken hematogonların dışlanmasının gerekliliğini vurgulamak amacı ile tartışılmıştır.

ABSTRACT B-lymphocyte progenitor cells, so-called hematogones, and mature B lymphocytes are normal bone marrow constituents, which are more prominent in the pediatric bone marrow. Increased numbers of hematogones may cause problems in diagnosis because of the morphologic features they commonly share with the neoplastic lymphoblasts of acute lymphoblastic leukemia and lymphoblastic lymphoma. However, an increase in some of hematogones due to unknown viral infections, after high dose chemotherapy had been rarely reported in the literature. We describe here a case of a three-month-old male infant with lymphocytosis associated with increased hematogones in the bone marrow due to an unknown probable viral infection. 

Anahtar Kelimeler

• Hematogon,infant,lenfositoz,lösemi

Kaynakça

1. 1. Rimsza LM, Larson RS, Winter SS, Foucar K, Chong YY, Garner KW, et al. Benign hematogonerich lymphoid proliferations can be distinguished from B-lineage acute lymphoblastic leukemia by integration of morphology, immunophenotype, adhesion molecule expression, and architectural features. Am J Clin Pathol 2000;114:66-75.
2. 2. McKenna RW, Washington LT, Aquino DB, Picker LJ, Kroft SH. Immunophenotypic analysis of hematogones (B-lymphocyte precursors) in 662 consecutive bone marrow specimens by 4-color flow cytometry. Blood 2001;98:2498-507.
3. 3. Babusıkova O, Zeleznıkova T, Kirschnerov G, Kankuri E. Hematogones in acute leukemia during and after therapy. Leuk Lymphoma 2008;49:1935-44.
4. 4. Koca E, Buyukasik Y, Cetiner D, Yilmaz R, Sayinalp N, Yasavul U, et al. Copper deficiency with increased hematogones mimicking refractory anemia with excess blasts. Leuk Res 2008;32:495-9.
5. 5. Agarwal K, Aggarwal M, Aggarwal VK, Pujani M and Nain M. Increased hematogones in an infant with bicytopenia and leucocytosis:a case report. Cases Journal 2010;3:75.
6. 6. Moreno-Madrid F., Uberos J, Dıaz-Molina M, Jiménez-Gámiz P, Molina-Carballo A. The presence of precursors of benign pre-B lymphoblasts (hematogones) in the bone marrow of a pediatric patient with cytomegalovirus infection. Clin Med Oncol 2008;2:437-9.
7. 7. Akyay A, Falay M, Öztürkmen S, Biçakci Z, Tavil B, Ozet G, et al. Hematogones in ımmune thrombocytopenic purpura: diagnostic implication. The Turkısh Journal of Pediatrics 2011;53:219-24.
8. 8. Rego EM, Garcia AB, Viana SR, Falcao RP: Age-related changes of lymphocyte subsets in normal bone marrow biopsies. Cytometry 1998;34:22-9.

9. 9. Kalff A, Juneja S. B-acute leukemic lymphoblasts versus hematogones: the wolf in sheep’s clothing. Leuk Lymphoma 2009;50:523-4.
10. 10. Smedmyr B, Bengtsson M, Jakobsson B, Oberg G, Totterman TH. Regeneration of CALLA (CD10), TdT and double-positive cells in the bone marrow and blood after autologous bone marrow transplantation. European Journal of Hematology 1991;46:146-51.