Acute leukemias 2-csbrp
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Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid cells in the bone marrow. There are two main types of acute leukemia - ALL and AML. ALL is further classified using the FAB or WHO systems and is most common in children under 5 years old. The disease involves a proliferation of lymphoblasts in the bone marrow. Microscopically, ALL blasts can be classified as L1, L2, or L3 depending on their size, shape, and other characteristics. Immunophenotyping and cytogenetic testing are also used in the diagnosis and classification of ALL. Presenting symptoms are non-specific and related to low blood cell counts.
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Acute leukemias 2-csbrp
- 1. Acute LymphoblasticAcute Lymphoblastic leukemias -leukemias - ALLALL Dr.CSBR.Prasad, M.D.
- 3. Name the two main types of acute leuemias?
- 4. Name the two popular classifications used in acute leukemias?
- 5. What is the required blast percentage for the diagnosis of acute leukemia?
- 6. When do you clinically suspect acute leukemia?
- 7. Name the stains used to differentiate AML from ALL?
- 8. How WHO classification differs from FAB classification of acute leukemias?
- 9. ALL The acute lymphoblastic leukemias (ALLs) are systemic neoplastic proliferations of lymphoblasts that have their origin in a bone marrow lymphocyte progenitor cell.
- 10. ALL • Disease of the children and young adults • With a peak incidence at 4yrs of age • The most common childhood leukemia (80%) • More common in boys • It can occur in adults (less frequent)
- 11. ALL Classification: FAB (Morphological, immunological) • Divided in to 3 types ALL L1, L2 & L3 • L1 is most common in children (85%) • L2 is common in adults • 80% of ALLs are of B-cell origin (CD 19)
- 12. FAB classificationFAB classification o L1: small cells predominate 2x the dia of small lymphocyte, Nuclei round regular, occasional cleft. Nucleoli not visible. Cytoplasm is scanty. Homogeneous population o L2: heterogeneous in size, share features of L1 & L3. Nuclei show clefts, Nucleoli+ o L3: homogeneous population of large cells, 3-4x dia of small lymphocytes, nuclei are round, oval with prominent nucleoli. Cytoplasm abundant deeply basophilic, Vacuolated.
- 13. ACUTE LYMPHOBLASTIC LEUKEMIA, L1 (ALL-L1) L1: small cells predominate 2x the dia of small lymphocyte, Nuclei round regular, occasional cleft. Nucleoli not visible. Cytoplasm is scanty. Homogeneous population
- 14. Name the stains employed to distinguish AML from ALL?
- 15. PAS – Block positivity
- 16. IMMUNOPEROXIDASE STAIN FOR TdT ON A BONE MARROW SMEAR FROM A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA The nuclear distribution of the stain corresponds to the location of TdT in the lymphoblasts.
- 17. ALL L1 Bone marrow
- 18. ALL L2: Heterogeneous in size, share features of L1 & L3. Nuclei show clefts, Nucleoli+
- 19. ACUTE LYMPHOBLASTIC LEUKEMIA, L2 (ALL-L2) The lymphoblasts vary in size, have reticular chromatin, prominent nucleoli, and lack the nuclear irregularity of the blasts. A minority of the lymphoblasts have the cytologic features of ALL-L1. (Wright-Giemsa stain)
- 20. ALL - L3: Homogeneous population of large cells 3-4x dia of small lymphocytes Nuclei are round, oval with prominent nucleoli Cytoplasm abundant deeply basophilic, vacuolated
- 21. ALL L3 Burkitt’s leukemia
- 22. ALL L3 Burkitt’s leukemia
- 23. ALL L3 A methyl green pyronine (MGP) stain on the left shows strong uniform staining of the cytoplasm. On the right the cytoplasmic vacuoles stain with oil red 0. MGP Oil red O
- 24. Chromosomal changes 1. Hyperdiploidy: upto 60 chr. Good prognosis 2. Ph’ L2 Poor prognosis 3. t(1,19) pre-B ALL, Poor prognosis 4. t(8,14) L3, Poor prognosis
- 25. Specific CF The presenting signs and symptoms are similar to those of AML and are usually related to blood cytopenias. Lethargy, malaise, fever, and infection are the most common. T-cell ALL : Mediastinal mass, Testis is involved ALL 3 (Burkitt’s): Maxilla is involved
- 26. Denis Burkitt
- 27. Aplastic Presentation of ALL Rarely, patients with ALL present with pancytopenia and a hypoplastic bone marrow. Leukemic blasts may not be identified initially. This hypocellular phase is typically followed by apparent bone marrow recovery and later by overt leukemia in a matter of weeks or a few months.
- 28. Some terms 1- Aleukemic leukemia 2- Sub leukemic leukemia 3- Leukemoid reaction
- 29. CYTOLOGIC FEATURES OF BLASTS IN ACUTE MYELOID & ACUTE LYMPHOBLASTIC LEUKEMIAS AMLAML ALLALL Blast sizeBlast size Medium to large, uniform Variable Small to medium CytoplasmCytoplasm Fine granules may be present Usually scant, a few coarse granules may be seen Auer rodsAuer rods Present in 60-70% of cases absent Nuclear chromatinNuclear chromatin Finely dispersed Fine to coarse NucleoliNucleoli 2-4, prominent 1-3, indistinct Other cell typesOther cell types Often dysplastic changes in maturing myeloid cells Myeloid cells are not dysplastic
- 30. E N D
Editor's Notes
- running, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.100.
- Disease of the children and young adults With a peak incidence at 4yrs of age Constitutes 80% of all childhood leukemias It can occur in adults but, with less frequency More common in boys
- ACUTE LYMPHOBLASTIC LEUKEMIA, L1 (ALL-L1) The lymphoblasts in the trephine biopsy section are smaller and have more condensed nuclear chromatin than those in figure 120. (Hematoxylin and eosin stain) Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.105.
- IMMUNOPEROXIDASE STAIN FOR TdT ON A BONE MARROW SMEAR FROM A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA The nuclear distribution of the stain corresponds to the location of TdT in the lymphoblasts. (Immunoperoxidase-anti-TdT reaction) Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.118.
- ACUTE LYMPHOBLASTIC LEUKEMIA, L2 (ALL-L2) A bone marrow smear from a 2-year-old female. The lymphoblasts vary in size and show considerable nuclear irregularity. There is a moderate amount of cytoplasm. The nuclei have coarse chromatin and contain distinct nucleoli. (Wright-Giemsa stain) Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.107.
- ACUTE LYMPHOBLASTIC LEUKEMIA, L2 (ALL-L2) The lymphoblasts in this bone marrow smear from a 12-year-old male vary in size, have reticular chromatin, prominent nucleoli, and lack the nuclear irregularity of the blasts in figure 125. A minority of the lymphoblasts have the cytologic features of ALL-L1. (Wright-Giemsa stain) Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.108.
- ACUTE LYMPHOBLASTIC LEUKEMIA, L3 (ALL-L3) A bone marrow smear from a 19-year-old male who presented with a paraspinal mass. The marrow was heavily infiltrated with the characteristic cells of ALL-L3. There is variation in size of the blasts but all have round or oval nuclei with coarsely reticular chromatin and deeply basophilic cytoplasm containing the characteristic vacuoles. Nucleoli are prominent in some of the cells. Three cells on the lower left of this field are in mitosis. An eosinophil myelocyte and neutrophil promyelocyte are also present in this field. A tissue mass commonly accompanies ALL-L3, frequently in the ileocecal region. The morphologic features of L3 are identical to those of small noncleaved cell lymphomas. (Wright-Giemsa stain) (Fig. 37.23 (right) from McKenna RW. The bone marrow manifestations of Hodgkin's disease, the non-Hodgkin's lymphomas, and lymphoma-like disorders. In Knowles DM, ed. Neoplastic hematopathology. Baltimore: Williams & Wilkins, 1992:1135-80.) Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.111. Figure 134
- ACUTE LYMPHOBLASTIC LEUKEMIA, L3 (ALL-L3) A blood smear from a young man with an elevated leukocyte count. The leukemic cells are relatively uniform with a moderate amount of deeply basophilic cytoplasm and round nuclei. The chromatin is coarsely reticular; indistinct nucleoli can be identified in some of the blasts. The cytoplasm contains several sharply defined clear vacuoles. Some of the vacuoles overlie the nucleus. The blood contained an unusually large number of blasts in this case. (Wright-Giemsa stain) Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.111.
- ACUTE LYMPHOBLASTIC LEUKEMIA, L3 (ALL-L3) A bone marrow smear from a 19-year-old male who presented with a paraspinal mass. The marrow was heavily infiltrated with the characteristic cells of ALL-L3. There is variation in size of the blasts but all have round or oval nuclei with coarsely reticular chromatin and deeply basophilic cytoplasm containing the characteristic vacuoles. Nucleoli are prominent in some of the cells. Three cells on the lower left of this field are in mitosis. An eosinophil myelocyte and neutrophil promyelocyte are also present in this field. A tissue mass commonly accompanies ALL-L3, frequently in the ileocecal region. The morphologic features of L3 are identical to those of small noncleaved cell lymphomas. (Wright-Giemsa stain) (Fig. 37.23 (right) from McKenna RW. The bone marrow manifestations of Hodgkin's disease, the non-Hodgkin's lymphomas, and lymphoma-like disorders. In Knowles DM, ed. Neoplastic hematopathology. Baltimore: Williams & Wilkins, 1992:1135-80.) Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.111. Figure 134
- ACUTE LYMPHOBLASTIC LEUKEMIA, L3 (ALL-L3) Bone marrow smear from an 8-year-old male. A methyl green pyronine (MGP) stain on the left shows strong uniform staining of the cytoplasm. On the right the cytoplasmic vacuoles stain with oil red 0. Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.113.
- Brunning, RD and McKenna, RW. Tumors of the bone marrow. Atlas of Tumor Pathology, 3rd Series, Fascicle 9. Washington D.C.:Armed Forces Institute of Pathology, 1993. p.100.
- 1- Aleukemic leukemia: Normal total leucocyte count with anemia & thrombocytopnia.Therd may be an occasional blast in teh peripheral blood smear. 2- Sub leukemic leukemia: Leucopeniam with a few blasts and anemia and thrombocytopenia. 3- Leukemoid reaction: Elevated count with a few immaure cells like myelocyte and metamyelocyte. Because of high count it may mimic leukemia. However, total count will not exceed 50K.