Introduction: Mixed-phenotype acute leukemia (MPAL) is a rare, biologically highrisk acute leukemia characterized by blasts expressing markers of more than one hematopoietic lineage. It accounts for <4% of acute leukemias. MPAL with B- and T-lineage differentiation (MPAL-B/T) is exceptionally rare, comprising ~6% of MPAL cases, with limited pediatric reports. Accurate recognition is critical, as this entity carries distinct therapeutic and prognostic implications compared with lineage-defined leukemias. Case Presentation: We report a 12-year-old Filipino female presenting with epistaxis, pallor, and easy bruising. Laboratory studies revealed severe anemia, hyperleukocytosis, and circulating blasts. Peripheral blood flow cytometry revealed 73% blasts co-expressing T-lineage markers (surface and cytoplasmic CD3, CD5, CD7) and B-lineage markers (CD19, cytoplasmic CD79a), with CD34 and HLA-DR. Bone marrow flow cytometry confirmed persistent dual-lineage expression in blasts comprising 21% of total events. Discussion: The findings meet WHO diagnostic criteria for MPAL, with definitive T-lineage assignment via cCD3 and strong B-lineage expression with CD19 and cCD79a. By European Group for the Immunological Classification of Leukemias criteria, lineage scores were 3.5 (T) and 3 (B), consistent with biphenotypic leukemia. MPAL has inferior survival compared with lineage-defined ALL and remains therapeutically challenging due to uncertainty in optimal induction strategy. Emerging data support ALL-directed regimens with risk-adapted consolidation, underscoring that precise immunophenotypic classification informs treatment algorithms and risk stratification. Misclassification as isolated T-ALL or B-ALL may lead to inappropriate therapy and poorer outcomes. Conclusion To our knowledge, this is the first reported Filipino pediatric MPALB/T case, emphasizing the need for comprehensive immunophenotyping and local molecular and outcome data to guide evidence-based management.
Leukemia, Biphenotypic, Acute ; Phenotype ; T-Lymphocytes

Percutaneous endoscopic gastrostomy (PEG) is commonly performed for feeding difficulties, in patients suffering from complications of nasopharyngeal carcinoma and its treatment, namely radiotherapy and surgery. This case report describes the challenges in hemostasis and subsequent re-establishment of enteral access for feeding, in an elderly patient with a history of NPC, treated surgically, followed by radiotherapy, who presented with massive hematemesis following reinsertion of her PEG shortly after an accidental dislodgement. Her previous nasopharyngectomy, wide field radiation therapy, and radical neck dissection precluded nasogastric tube feeding, and the presence of a large hiatus hernia made reinsertion of a new PEG technically challenging. This case highlights the methods used to overcome the above challenges.
Aged ; Enteral Nutrition ; Esophageal Stenosis ; Gastrostomy ; Hematemesis ; Hemostasis ; Hernia, Hiatal ; Humans ; Intubation, Gastrointestinal ; Neck Dissection ; Radiotherapy ; Stomach Ulcer ; Ulcer