Abstract
An 80 year-old man was admitted to hospital because of leukocytosis. Physical examination revealed no remarkable change. On admission, the white blood cell count was 18000/μl with a differential count of 12% band forms, 81% segmented forms and 7% others. The red blood cell count was 399×104/μl. The platelet count was 7.5×104/μl. NAP score was 459. Cytologic study of the bone marrow (BM) showed myeloid hyperplasia as follows: 88.8% myeloid series, 6.6% erythroid series and 4.6% others. The CFU-GM was 36/2×105 BM-mononuclear cells. Cytogenetic study showed trisomy of chromosome 8 (100%) and partial deletion of the long arm of chromosome 3 (61.5%). Ph1 chromosome was negative. Serum vitamin B12 was 15830 pg/ml. Bacteriologic examinations were negative. According to these findings, a diagnosis of chronic neutrophilic leukemia was made.
The white blood cell count gradually rose to 38200/μl. About 8 months later, white cells decreased to 1500/μl, red cells to 269×104/μl and platelets to 1.5×104/μl without chemotherapy. On July, 6, 1985, he died of fungal pneumonia. Postmortem examination revealed hypoplastic bone marrow with some macrophages but the infiltration of neutrophils and macrophages in the liver and spleen were absent.
