Isochromosome 1q in Childhood Burkitt Lymphoma: The First Reported Case in Korea

Dear Editor Aberrations of the human chromosome 1 are common in hematologic malignancies such as multiple myeloma, myeloproliferative disorders, and myelodysplastic syndrome, highlighting their significance in carcinogenesis [1]. The isochromosome 1q [i(1)(q10) or i(1q)] is a distinctive structural chromosomal abnormality in hematologic malignancies [2], especially in childhood Burkitt lymphoma/leukemia (BL) [3]. We report the first Korean pediatric BL patient with i(1)(q10) as well as t(8;14) (q24;q32). A 9-yr-old girl with fever for three days was referred to our hospital for abnormal complete blood count, which revealed the following: hemoglobin, 8.4 g/dL; platelets, 12×10/L; and leukocyte count, 4.46×10/L with 9% lymphoma cells (Fig. 1A). Subsequent physical examinations revealed splenomegaly and several palpable lymph nodes. The patient also showed swelling at both submandibular areas, which developed the day before admission. Even though the initial bone marrow specimen was dry-tapped and inadequate for accurate differential count, lymphoma cells with bluish cytoplasm and prominent nucleoli were heavily loaded on touch imprint preparation (Fig. 1B). Flow cytometric analysis performed with peripheral blood specimen presented that the lymphoma cells were positive for CD19 and CD10; but negative for CD20, terminal deoxynucleotidyl transferase (TdT), kappa, and lambda surface immunoglobulins. Chromosomal analysis of the bone marrow specimen using standard trypsinGiemsa banding technique revealed an abnormal karyotype of 47,XX,+i(1)(q10),t(8;14)(q24;q32)[17]/49,idem,+6,+14[6]/ 46,XX[4] (Fig. 2A). FISH was performed to confirm the abnormality, which indicated the presence of i(1)(q10) (Fig. 2). She was diagnosed as having BL and treated with vincristine and daunorubicin. Although she presented jaundice and liver enzyme elevation that were considered as toxic side effects of the chemotherapy, the patient tolerated the induction and consolidation chemotherapy quite well. Follow-up bone marrow examination and cytogenetic analyses showed no residual lymphoma cells with the 46,XX[20] karyotype. Informed consent was obtained from the patient’s parents for the case report. Among various types of recurrent chromosomal aberrations reported in BL patients, chromosomes 1, 6, 7, 13, 17, and 22 are most frequently affected in up to 70% of the cases [4]. In comparison with other structural rearrangements within the long arm of chromosome 1 [5], i(1)(q10) is unique for genetic dosage gain, which results in a complete triplicate of 1q and distinctive morphologic feature. There were three cases of child-