Synchronous Diagnosis of De Novo Acute Myeloid Leukemia with inv(16)(p13q22) and Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature

The occurrence of de novo acute myeloid leukemia (AML) with chronic lymphocytic leukemia (CLL) is rare. Most cases of hematologic malignancies such as AML occurring in patients with pre-existing CLL are therapy-related. In this report, we describe a 65-year-old male with no past history of a hematolymphoid malignancy, who presented with abdominal pain. He was evaluated for acute diverticulitis, and incidentally found to have 14% circulating blasts upon peripheral blood smear review for anemia and thrombocytopenia. Bone marrow biopsy revealed 30-40% blasts and lymphoid aggregates. In conjunction with cytogenetics studies, a diagnosis of de novo AML with inv(16)(p13q22) CBFB-MYH11, trisomy 8, monosomy 18, and concurrent CLL with trisomy 12 was made. Serial FISH studies were used to demonstrate that the nuclei with (CBFB-MYH11) fusion did not have trisomy 12 and it was concluded that AML and CLL cells arose from separate clones. He died 3 weeks following presentation from complications of diverticulitis. To our knowledge, this is the second reported case of de novo AML with inv(16) and CLL.