-

-

-

66 yrs

M

-

+

+ Slightly enlarged lymph nodes (submental, cervical, axial, mediastinal, inguinal) were detected by computed tomography.

-

130.4

13.9

40

93

Hypercellular marrow (NCC 497109/l) with 93.8% blast; monotonous and high nuclear-cytoplasm (N/C) ratio blast cells which had a cleaved nuclear were expanded.

Mixed phenotype acute leukaemia, T/myeloid, NOS

Positve for CD2,cyCD3,CD7,CD13,CD15,CD34,HLA-DR, and dimly positive for CD33,MPO,TdT. Negative for CD1a,CD5,CD11b,CD117,TCR-AB,TCR-GD

Not performed.

Acute leukemia compatible.

Not performed.

Mixed phenotype acute leukemia, T/myeloid, NOS.

04-2015

Japan adult leukemia study group T-ALL213-O induction therapy including vincristine (VCR), cyclophosphamide (CPA), daunorubicin (DNR), L-Asparaginase (L-ASP) and Predonisolone (PSL).

+

-

-

A

09-2015

5

Bone marrow

24-48

G-banding

46,XY,t(6;14)(q25;q32) [20]

not applicable

fluorescence in situ hybridization(FISH) analysis using IgH 3 flanking region/V probes. 14q32 (IgH) break apart probe is a mixture of two probes, 3 IgH flanking probe and IgH variable region probe as shown in Figure 2a.

Negative for immunoglobulin heavy chain (IgH) translocation (Figure 2b).

Polymerase chain reaction (PCR) and Sanger sequencing

Positive for Flt3-internal tandem duplication(ITD). Negative for c-kit mutation.

We present an adult case of biphenotypic acute leukemia with t(6;14)(q25;q32). Chromosome translocations involving 14q32 are generally represented by B cell neoplasms, because the immunoglobulin heavy chain (IgH) gene is located in this region. However, BCL11B gene also located in 14q32 was shown to be involved in this translocation (Bezrookove et al.,2004). BCL11B, a member of the Kruppel family of zinc finger trascription factors, plays a critical role in T cell development and functions as a tumor suppressor (Wakabayashi et al.,2003). The partner gene of this translocation is unknown. The 28S ribosomal DNA (RN28S1) was reported as a candidate fusion partner (Kobayashi et al.,2014), but this gene is not located in 6q25. The phenotype of haematological malignancies with t(6;14)(q25;q32) is variable. These include acute lymphoblastic leukemia (ALL) (Heerema et al.,2002), mixed phenotype acute leukemia (Hayashi et al.,1990, Batanian et al.,1996, Georgy et al.,2008, Kobayashi et al.,2014), acute myeloid leukaemia (AML) (Raimondi et al.,1989, Bezrookove et al.,2004), chronic T cell neoplasm (Inwards et al.,1990) and chronic lymphocytic leukaemia (CLL) (Mayr et al.,2006). In 7 of 9 acute leukaemia cases with this translocation, both myeloid and T-cell lineage markers were detected. No immunophenotype was described in the remaining two cases. This translocation may affect expression of T-cell lineage marker, but the role of BCL11B is unclear.