The median interval of six months between the two diagnoses in these patients contrasts sharply to the 25 to 60 month interval commonly seen in typical therapy-related hematologic malignancies. In addition, there was no identifiable prodrome of pancytopenia or characteristic cytogenetic abnormalities as is usually seen with therapy-related leukemias and myelodysplastic disorders. Reviews at Indiana University and elsewhere of patients receiving identical cisplatin-based chemotherapy suggest that such therapy is not leukemo-genic. antibiotics levaquin
This large number of cases of mediastinal nonseminomatous germ cell tumors associated with the prompt development of a hematologic malignancy suggests that there is a unique and biologically important linkage between these two malignancies. The most plausible explanation for the development of this syndrome is that the hematologic malignancy is a consequence of multipotential differentiation capacity of the malignant germ cell. Recently, Bosl and colleagues report the finding of the isochromosome of chromosome 12, i(12p), as a marker chromosome in the cytogenetic analysis of bone marrow in a patient with mediastinal germ cell tumor and leukemia. Cytogenetic analysis of the primary mediastinal germ cell tumor revealed an identical karyotype. The i(12p) is a characteristic karyotypic abnormality for all histologic variants of germ cell tumors and is not known to be associated with the development of leukemia. The finding of the most common karyotypic abnormality of germ cell tumors in a mediastinal germ cell tumor and in the leukemic blasts implies that the hematologic malignancy and the mediastinal germ cell tumor arose from a common progenitor cell. The findings of i(12p) on bone marrow cytogenetic analysis of one of the patients at Indiana University supports this argument.
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