TIAN Yuan, LIU Hui, CHANG Nai-bai and LI Jiang-tao

    To the editor: A 25-year-old male had been well until October 2009, when he developed abdominal pain, diarrhea, and fever. The results of the hematological examination were as follows. White blood cells were 108.76×109/L. The bone marrow was hypercellular with 32.5% lymophoblasts and 55.5% infantile lymphocytes which were cytochemically positive for PAS. Flow cytometric analysis revealed that the blasts were positive for CD7, CD2, CD3, CD8, TCR-α-β-1, CD38, CD19, CD13, pgP, CD56, cyCD79a, and CD117. Cytogenetic examination showed 45,XY,-8,der(9)t(8;9)(q12,p12)[5]/46,XY[20]. Finally, a diagnosis of biphenotypic acute leukemia (T/B) was made. Meanwhile, the patient suffered from disseminated intravascular coagulation, and recovered after treatment of fibrinogen. Then, he started receiving chemotherapy and got hematologic complete remission after the second session. Nevertheless, the central nervous system (CNS) leukemia was discovered. Immediately, he was treated successively with intrathecal injections for six times. The flow cytometry of bone marrow and cerebrospinal fluid were negative after the fifth course of chemotherapy. A cycle of consolidation treatment was followed. Later, the patient prepared to undergo an allogeneic stem cell transplant. Though, the next day after entering into the clean room, he presented with conjunctival congestion, blurred vision, and pain in the right eye. Morrow hypopyon had been identified. He was diagnosed as uveitis and secondary glaucoma. Fundus fluorescein angiography demonstrated iris neovascular of the right eye. Anterior chamber paracentesis was ultimately done in June 2010. On the third microscopic examination, a smear of the aspirated fluid showed a large number of blast cells (Figure 1). The flow cytometry showed that the proportion of abnormal cells to nucleated cells was 96.58%; the double mark masculine cell account for 64%, namely CD7 and CD19 expressions.