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Myeloid and lymphoid sinchronous neoplasm with t(8;13) (p12;q12) - FGFR1 in a positive SARS-CoV-2 patient: Case report


Hematology & Transfusion International Journal
Picallo Lombardía P, Pereiro Sanchez M, Sastre Moral JL

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Abstract

He went to Hospital because of fever and throat pain, with SARS-CoV2 infection at the same time. Initial blood tests showed hyperleukocytosis (49,320 x 10^3µL) and high cell count of neutrophils (39,440x10^3µL). Peripheral blood studies were suggestive of myeloproliferative Syndrome, and SARS-CoV-2 test was positive. Flow citometry (FCM) studies showed lymphocytes with patological inmunophenotype (CD3-) indicative of lymphoid component. Genetic studies showed 8p11/FGFR1 traslocation with caryotipe: 46,XY,t(8;13)(p11.2;q12) [22]/46,XY[3]. Myeloid genetical studies were negative, but TCR was positive. We concluded he presented lymphoid / myeloid complex neoplasm Hematology & Transfusion International Journal Case Report Open Access with significant tumor burden at debut, which is characteristic of this traslocation. Bone marrow and peripheral blood studies were compatible with myeloproliferative Neoplasm, even though genetic studies guide to lymphoid disease. Both ganglio biopsy and FCM of bone marrow diagnosed a T-lymphoma. B symptoms (asthenia and weight loss) and palpable lymphadenopaties also indicate T component. This complex hematological neoplasm was aggravate by SARS-CoV-2 infection. It was decided to treat the haematological disease once the infection was solved. Patient received standard doses according to usual protocol for T acute lymphoblastic leukemia (T-ALL) in Spain, in an alogenic stem cell trasplant (ASCT) candidate. Also SARS-CoV2 infection was treated and solved. Now patient is responding to treatment, showing antibodies to the virus. With control-test negatives until today doing every two weeks, recommended by Infectious disease department of our center. Grow factor receptor (FGFR) is a non-exclusive molecule of human being. Four different types of FGFR are known in our environment. FGFR tirosin kinase activity has a N-terminal sequence codified by FIM gene, which joins the kinase domain. This covalent bond is responsible for oncogenic potential of this hematopoietic cells. The gen receptor plays an important role in Hematopoiesis. Its hyperactivity leads to abnormalities in signal pathways, resulting with cellular mutations or Hematological neoplasms.1 Abnormalities in this factor are also responsible for genetic diseases such as Pffeifer or Kallman syndrome (FGFR3). Also tumors (FGFR1- lymphoblastic lymphomas) or genetic traslocations related to Hematological malignancies are described. They are usually associated to chromosome eight traslocation (t8;13), as a result of gene fusion ZMYM2(ZNF198)-FGFR1. Few cases are registered about 8p11/FGFR1 traslocation-related neoplasms at literature. Mixed myelo-lymphoid neoplasms are usually related to this traslocation.2 This neoplasms associated with FGFR1 mutation frequently get the origin in Stem cell, resulting in a wide and heterogeneus clinical presentation.3

Keywords

throat pain, lymphadenopaty, splenomegaly, Epstein Barr Virus,

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