case_images: PMC10871153_01
case_images: Subcutaneous tissue of the left antebrachium, soft shadow in the left maxillary sinus on cervical computed tomography before and after venetoclax/azacitidine treatment.. A subcutaneous tissue of the left antebrachium with a size of 60 x 30 mm (A), a soft shadow in the left maxillary sinus on cervical computed tomography (CT) (B), and a mass in the left axilla on thoracic CT (C) observed on admission. After the first venetoclax/azacitidine therapy cycle, a scar on the subcutaneous tissue with a size of 28 x 24 mm (D) was observed, and soft shadow (E) and mass in the left axilla (F) disappeared.
case_images: cureus-0016-00000052446-i01.jpg
case_images: PMC10871153_01_cureus-0016-00000052446-i01.jpg
case_images: FIG1
case_images: Computed tomography (CT) revealed a soft shadow in the left maxillary sinus and multiple masses extending from the left axilla to the supraclavicular fossa (Figure 1, Panels B, C). BM suppression. BM examination results showed the disappearance of pathological cells, while CT showed the disappearance of a soft shadow in the left maxillary sinus and multiple masses (Figure 1, Panels D-F).
case_images: Bone marrow smears before treatment.. Bone marrow smears show medium-to-large-sized pathological cells with vacuoles and granules with round or irregular nuclei and a nuclear/cytoplasm ratio of 60-80% (A, x400).. Histopathological examination of the bone marrow on hematoxylin and eosin-stained images shows diffuse infiltration of the pathological cells (B, x40; C, x400).
case_images: cureus-0016-00000052446-i02.jpg
case_images: PMC10871153_01_cureus-0016-00000052446-i02.jpg
case_images: FIG2
case_images: The smear of BM aspirates revealed a nucleated cell count of 13.2 x 104/microL, with 74.8% pathological cells (Table 2, Figure 2).
case_images: Histopathological examination of pathological cells.. Histopathological examination of pathological cells stained with hematoxylin and eosin shows diffuse infiltration (A, x40; B, x400). Immunohistochemical staining shows pathological cells with high CD4 (C, x400), CD56 (D, x400), CD123 (E, x400), TdT (F, x400), and BCL2 (G, x400) and low MYC (H, x400) protein expression.
case_images: cureus-0016-00000052446-i03.jpg
case_images: PMC10871153_01_cureus-0016-00000052446-i03.jpg
case_images: FIG3
case_images: MPO(-), and MYC(-). MYC rearrangements were not detected (Figure 3).
case_images: Course of treatment and blood count of the patient.. Six days after the initiation of VEN/AZA therapy, pathological cells were not detected in the peripheral blood. Twenty-eight days after the initiation of VEN/AZA therapy, the therapeutic efficacy was evaluated as a complete response based on bone marrow testing and computed tomography findings. Fifty-six days after the initiation of VEN/AZA therapy, the patient developed febrile neutropenia and received a subcutaneous injection of filgrastim and antimicrobial therapy with cefepime. Sixty-nine days after the initiation of VEN/AZA therapy, while the patient received the third cycle of VEN/AZA therapy, subcutaneous AZA injections were discontinued due to bone marrow suppression. The patient was started on VEN monotherapy at a dose of 200 mg/day, which was increased to 300 mg/day mg/day 104 days after the initiation of VEN/AZA therapy. The patient continued to receive VEN monotherapy for 15 months without any adverse events or relapse.. AZA: azacitidine; VEN: venetoclax; CFPM: cefepime; BM: bone marrow; WBC: white blood cells; PLT: platelets; Hb: hemoglobin
case_images: cureus-0016-00000052446-i04.jpg
case_images: PMC10871153_01_cureus-0016-00000052446-i04.jpg
case_images: FIG4
case_images: He has continued VEN monotherapy and has remained in CR with normal s-IL2R values for 15 months since the BPDCN diagnosis (Figure 4).