Differential diagnosis for eosinophilia:
Reactive/Secondary 1). Benign conditions:
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Primary
1) Neoplastic 1. Myeloid or lymphoid neoplasm with abnormality of PDGFRA, PDGFRB, FGFR1 or PCM1-JAK2 2. Chronic eosinophilic leukemia, NOS 3. Some MPN, MDS, MDS/MPN or AML 2) Idiopathic hypereosinophilic syndrome Diagnosed only after full investigation: a. eosinophil count:1.5k/ul for over 6mon; b. reactive eosinophilia excluded by thorough investigation; c. AML, MPN, MDS, MDS/MPN, mastocytosis excluded; d. Aberrant cytokine-producing T cell population excluded; e. tissue damage. If criteria a-d are met but there is no tissue damage, it should be called idiopathic hypereosinophilia. Presence of blasts in the PB and dysplasia indicate neoplastic eosinophilia.
This case: No blasts or immature granulocytes are present in PB. BM does not show dysplasia. These findings favor non-neoplastic eosinophilia. Thorough work up is needed for etiology. |
2). Eosinophilia related to phenotypically aberrant T cells producing IL5 3). Kimura's Disease 4). Angiolymphoid hyperplasia with eosinophilia 5). Eosinophilia-myalgia syndrome 6). 2nd to malignancy: Hodgkin lymphoma, Systemic mastocytosis, T-cell lymphoma, acute lymphoblastic leukemia [esp., t(5;14)IL3/IHGH], solid tumor ----------------------------------------------------------------------------------------------------------------- |