1. Fellow, Dept of Hematopathology 1515 Holcombe Blvd, Unit 072
Huifei Liu, MD, PhD
Fellow, Dept of Hematopathology
1515 Holcombe Blvd, Unit 072
The University of Texas at MD Anderson Cancer Center
Houston, TX 77030

2. Clinical History 71-year-old man
Anemia for several months with recent progressive shortness of breath
PMH: asthma, hypertension, BPH, hyperlipidemia
Testosterone supplement since 4/2013
Splenomegaly

3. PB: Blasts (18%) with eosinophilia (29%) and Anemia

4. PB: Atypical eosinophil

5. BM: 30% Blasts with 15% eosinophils

6. BM: ↑Immature Cells, Eosinophils, Megakaryocytyes

7. BM: Megakaryocytic Hyperplasia/Dysplasia

8. Flow Cytometry

9. Flow Cytometry

10. Immunophenotype of Blasts
CD34+/CD117+/CD45+ CD13+/CD33+/CD38+/HLADR+ CD4dim/CD5dim/CD7p+/CD25p+/CD56+ MPO− CD2−/CD3−/CD10−/CD14−/CD15− CD19−/CD123−/TdT−

11. Cytogenetics & Molecular Diagnostics
45,XY,-7[20]
FLT3 ITD
ASXL1
PTPN11
PDGFRA rearrangement (-)
PDGFRB rearrangement (-)
BCR/ABL1 (-)
CHIC2 deletion (-)

12. Diagnosis ACUTE MYELOID LEUKEMIA WITH FLT3-ITD MUTATION
IN A BACKGROUND OF
MARKED EOSINOPHILIA
AND MARKED MEGAKARYOCYTIC HYPERPLASIA

13. Discussion 1+1=? 1+1+1=? 1+1+1+……=?
How does multiple mutations interact to shape clinical presentation and treatment responses?
1+1=? 1+1+1=? ……=?