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LETTERS TO THE EDITORTurk J Hematol 2018;35:75-93first case was a 57-year-old man with acute myelomonocyticleukemia and concomitant inv(16). Exact morphologic andimmunophenotyping characteristics of this case were notdetermined [2]. The second case was a 13-year-old boy withacute myeloid leukemia (M0) who developed multiple clonalabnormalities during his treatment course [3]. The present case isthe first patient with acute myelomonocytic leukemia with t(9;19)(q22;p13) as the sole chromosomal abnormality. This cytogeneticfinding and its associated morphologic and immunophenotypingcharacteristics are noteworthy and merit attention.Keywords: Acute myeloid leukemia, Cytogenetic, MonocyticdifferentiationAnahtar Sözcükler: Akut miyeloid lösemi, Sitogenetik, MonositikfarklılaşmaReferences1. Yang JJ, Park TS, Wan TSK. Recurrent cytogenetic abnormalities in acutemyeloid leukemia. In: Wan TSK (ed). Cancer Cytogenetics. New York,Springer Nature, 2017.2. Buonamici S, Ottaviani E, Testoni N, Montefusco V, Visani G, Bonifazi F,Amabile M, Terragna C, Ruggeri D, Piccaluga PP, Isidori A, Malagola M,Baccarani M, Tura S, Martinelli G. Real-time quantitation of minimalresidual disease in inv(16)-positive acute myeloid leukemia may indicaterisk for clinical relapse and may identify patients in a curable state. Blood2002;99:443-449.3. Ostronoff F, Bueso-Ramos C, Cortes J, Giralt S. Normal hematopoieticfunction and multiple bone marrow clonal abnormalities in a patient withacute myeloid leukemia after two mismatched stem-cell transplants withgraft failure and autologous reconstitution. Am J Hematol 2007;82:744-747.Address for Correspondence/Yazışma Adresi: Moeinadin SAFAVI, M.D.,Tehran University Faculty of Medicine, Department of Pathology, Molecular Pathology and CytogeneticWard, Tehran, IranE-mail : safavi_moeinadin@yahoo.com ORCID-ID: orcid.org/0000-0002-4042-7506Received/Geliş tarihi: October 07, 2017Accepted/Kabul tarihi: December 28, 2017DOI: 10.4274/tjh.2017.036890
Turk J Hematol 2018;35:75-93LETTERS TO THE EDITORInvasive Aspergillosis in Refractory AngioimmunoblasticT-Cell LymphomaRefrakter Anjiyoimmünoblastik T-Hücreli Lenfomada İnvaziv AspergillozPrakash NP 1 , Anoop TM 1 , Rakul Nambiar 1 , Jaisankar Puthusseri 1 , Swapna B 21Regional Cancer Centre, Department of Medical Oncology, Thiruvananthapuram, India2Regional Cancer Centre, Department of Microbiology, Thiruvananthapuram, IndiaTo the Editor,A 40-year-old man with angioimmunoblastic T-cell lymphoma, onpalliative chemotherapy with lenalidomide at 20 mg, developedpancytopenia and progressive loss of vision and conjunctival swellingover the right eye after the second cycle (Figure 1). Brain magneticresonance imaging with orbit demonstrated endophthalmitis. Apus sample was inoculated onto routine bacteriological mediaand Sabouraud’s dextrose agar (SDA) for detection of fungalpathogens. On the 4 th day, fungal growth was observed on SDA. Thesurface of the fungal colony was initially white; it turned to a bluegreencolor and had a powdery texture. Lactose phenol cotton bluemount showed hyaline septate hyphae with short conidiophoresand vesicle-bearing chains of round conidia covering the upperhalf of the vesicle, suggestive of Aspergillus fumigatus. He wasstarted on parenteral voriconazole, but his condition worsened andhe died following severe fungal sepsis.Orbital invasive aspergillosis is a fatal condition, oftenmisdiagnosed, and the mortality rate remains high even afterproper treatment. Patients at risk for invasive aspergillosis includepatients with prolonged neutropenia, allogeneic hematopoieticstem cell recipients, solid organ transplant recipients, patients onchronic steroid therapy, and patients with HIV infection or chronicgranulomatous disease [1,2]. Among patients with hematologicconditions (both benign and malignant), the duration and grade ofneutropenia predict the risk of invasive aspergillosis. The incidenceof invasive aspergillosis in patients with hematologic malignancieshas been reported to be as high as 3.1%, with Aspergillus fumigatusrepresenting the most commonly isolated species [3]. Compared toamphotericin B, voriconazole demonstrates a survival benefit, lesssystemic toxicity, and better tolerance by patients [4].Figure 1. Photograph showing red conjunctival swelling over theright eye.Keywords: Lymphoma, Endophthalmitis, AspergillusAnahtar Sözcükler: Lenfoma, Endoftalmi, AspergillozConflict of Interest: The authors of this paper have no conflicts ofinterest, including specific financial interests, relationships, and/oraffiliations relevant to the subject matter or materials included.References1. Weinberger M, Elattar I, Marshall D, Steinberg SM, Redner RL, Young NS,Pizzo PA. Patterns of infection in patients with aplastic anemia and theemergence of Aspergillus as a major cause of death. Medicine (Baltimore)1992;71:24-43.2. Gerson SL, Talbot GH, Hurwitz S, Strom BL, Lusk EJ, Cassileth PA. Prolongedgranulocytopenia: the major risk factor for invasive pulmonary aspergillosisin patients with acute leukemia. Ann Intern Med 1984;100:345-351.3. Nicolle MC, Bénet T, Thiebaut A, Bienvenu AL, Voirin N, Duclos A, SobhM, Cannas G, Thomas X, Nicolini FE, De Monbrison F, Piens MA, Picot S,Michallet M, Vanhems P. Invasive aspergillosis in patients with hematologicmalignancies: incidence and description of 127 cases enrolled in asingle institution prospective survey from 2004 to 2009. Haematologica2011;96:1685-1691.4. Ohlstein DH, Hooten C, Perez J, Clark CL 3rd, Samy H. Orbital aspergillosis:voriconazole – the new standard treatment? Case Rep Ophthalmol2012;3:46-53.Address for Correspondence/Yazışma Adresi: Rakul NAMBIAR, M.D.,Regional Cancer Centre, Department of Medical Oncology, Thiruvananthapuram, IndiaE-mail : rakulnambiar@yahoo.com ORCID-ID: orcid.org/0000-0001-9670-3453Received/Geliş tarihi: June 13, 2017Accepted/Kabul tarihi: November 09, 2017DOI: 10.4274/tjh.2017.023691
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