Difference between revisions of "Leukemia"

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**Classic presentation: non-tender lymph nodes
**Classic presentation: non-tender lymph nodes


==Definition==
=Definition=
All of the following:<ref name=dg21mar20011>D. Good. 21 March 2011.</ref>
All of the following:<ref name=dg21mar20011>D. Good. 21 March 2011.</ref>
#Morphologic abnormalities.
#Morphologic abnormalities.
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*t(15;17).
*t(15;17).


==Histomorphologic overview==
=Histomorphologic overview=
{| class="wikitable"
{| class="wikitable"
| '''Disease/Feature'''
| '''Disease/Feature'''
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| '''Granulation of cytoplasm'''
| '''Granulation of cytoplasm'''
|-
|-
| AML
| Acute myeloid leukemia (AML)
| larger
| larger
| present
| present
| present
| present
|-
|-
| ALL
| Acute lymphoid leukemia (ALL)
| smaller
| smaller †
| none
| none
| absent or present
| absent or present
|}
|}
† should be easy to remember as smALL people, i.e. kids, get this type of acute leukemia.


==Clinical factors==
 
=Algorithms=
There is a nice set of algorithms from D. Arber - that were presented at the 2009 USCAP.
 
=Clinical factors in classification=
Clinical are important in the classification of leukemia.
Clinical are important in the classification of leukemia.
*Hx of [[myelodysplastic syndrome]]?
*Hx of [[myelodysplastic syndrome]]?
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*[[Down syndrome]]?
*[[Down syndrome]]?


==Algorithms==
=Leukemia classification=
There is a nice set of algorithms from D. Arber - that were presented at the 2009 USCAP.
 
==Leukemia classification==
Acute myeloid leukemia (AML):
Acute myeloid leukemia (AML):
#AML.
#AML.
Line 58: Line 60:
#T cell.
#T cell.


===Acute myeloid leukemia===
=Specific diagnoses=
==Acute myeloid leukemia==
*Abbreviated ''[[AML]]''.
*Abbreviated ''[[AML]]''.
====General====
===General===
*Adults.
*Adults.


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*[[Down syndrome]].
*[[Down syndrome]].


====Microscopic====
===Microscopic===
Features:
Features:
*Auer rods present
*Auer rods present
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*[http://commons.wikimedia.org/wiki/File:Auer_rods.PNG Auer rods in an AML (WC)].
*[http://commons.wikimedia.org/wiki/File:Auer_rods.PNG Auer rods in an AML (WC)].


====Molecular====
===Molecular===
*Must exclude all the recurrent cytogenetic abnormalities - see below.
*Must exclude all the recurrent cytogenetic abnormalities - see below.


===AML with recurrent cytogenetic abnormalities===
==AML with recurrent cytogenetic abnormalities==
====Acute myeloid leukemia with t(8;21)====
===Acute myeloid leukemia with t(8;21)===
*t(8;21)(q22;q22).<ref>{{Cite journal  | last1 = Berger | first1 = R. | title = Translocation t(8;21)(q22;q22): cytogenetics and molecular biology. | journal = Nouv Rev Fr Hematol | volume = 36 Suppl 1 | issue =  | pages = S67-9 | month =  | year = 1994 | doi =  | PMID = 8177719 }}</ref>
*t(8;21)(q22;q22).<ref>{{Cite journal  | last1 = Berger | first1 = R. | title = Translocation t(8;21)(q22;q22): cytogenetics and molecular biology. | journal = Nouv Rev Fr Hematol | volume = 36 Suppl 1 | issue =  | pages = S67-9 | month =  | year = 1994 | doi =  | PMID = 8177719 }}</ref>


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*CD19+, PAX5+, CD79a +/-.
*CD19+, PAX5+, CD79a +/-.


====Acute myeloid leukemia with inv(16)====
===Acute myeloid leukemia with inv(16)===
*inv(16)(p13.1q22).<ref name=pmid16917916>{{Cite journal  | last1 = Lu | first1 = CM. | last2 = Murata-Collins | first2 = JL. | last3 = Wang | first3 = E. | last4 = Siddiqi | first4 = I. | last5 = Lawrence | first5 = HJ. | title = Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: molecular evidence of two separate diseases. | journal = Am J Hematol | volume = 81 | issue = 12 | pages = 963-8 | month = Dec | year = 2006 | doi = 10.1002/ajh.20716 | PMID = 16917916 }}
*inv(16)(p13.1q22).<ref name=pmid16917916>{{Cite journal  | last1 = Lu | first1 = CM. | last2 = Murata-Collins | first2 = JL. | last3 = Wang | first3 = E. | last4 = Siddiqi | first4 = I. | last5 = Lawrence | first5 = HJ. | title = Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: molecular evidence of two separate diseases. | journal = Am J Hematol | volume = 81 | issue = 12 | pages = 963-8 | month = Dec | year = 2006 | doi = 10.1002/ajh.20716 | PMID = 16917916 }}
</ref>
</ref>
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*CD2+ -- common.
*CD2+ -- common.


====Acute myeloid leukemia with t(15;17)====
===Acute myeloid leukemia with t(15;17)===
*t(15;17)(q22;q12).
*t(15;17)(q22;q12).


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*t(5;17). (???)
*t(5;17). (???)


====Acute myeloid leukemia with t(9;11)====
===Acute myeloid leukemia with t(9;11)===
*t(9;11).
*t(9;11).


Line 150: Line 153:
*CD13+. (???)
*CD13+. (???)


==See also==
=See also=
*[[Lymphoma]].
*[[Lymphoma]].
*[[Myelodysplastic syndromes]]
*[[Myelodysplastic syndromes]]


==References==
=References=
{{Reflist|2}}
{{Reflist|2}}


[[Category:Haematopathology]]
[[Category:Haematopathology]]

Revision as of 15:39, 8 January 2012

The article addresses leukemia, which is uncommonly seen by anatomical pathologists. It is a subset of hematopathology.

Lymphoma is discussed in the lymphoma article, and overlaps somewhat with leukemia as the clear distinction between the two is historical (see below).

Historical classification:[1]

  • Leukemia = involves bone marrow +/- peripheral blood.
    • Classic presentation: infection, bleeding, anemia.
  • Lymphoma = discrete mass(es), usu. lymph node.
    • Classic presentation: non-tender lymph nodes

Definition

All of the following:[2]

  1. Morphologic abnormalities.
  2. >20% blasts or recurrent cytogenetic abnormality.

Some recurrent cytogenetic abnormalities:

  • t(8;21).
  • inv(16).
  • t(15;17).

Histomorphologic overview

Disease/Feature Blast size Auer rods Granulation of cytoplasm
Acute myeloid leukemia (AML) larger present present
Acute lymphoid leukemia (ALL) smaller † none absent or present

† should be easy to remember as smALL people, i.e. kids, get this type of acute leukemia.


Algorithms

There is a nice set of algorithms from D. Arber - that were presented at the 2009 USCAP.

Clinical factors in classification

Clinical are important in the classification of leukemia.

Leukemia classification

Acute myeloid leukemia (AML):

  1. AML.
  2. AML with recurrent cytogenetic abnormalities.
  3. AML from MDS.
  4. AML in the setting of Down syndrome.

Acute lymphoid leukemia (ALL):

  1. B cell.
  2. B cell with recurrent cytogenetic abnormalities.
  3. T cell.

Specific diagnoses

Acute myeloid leukemia

  • Abbreviated AML.

General

  • Adults.

Exclusions for this diagnosis:

Microscopic

Features:

  • Auer rods present
  • Cytoplasmic granularity.
  • Large cells.

Image:

Molecular

  • Must exclude all the recurrent cytogenetic abnormalities - see below.

AML with recurrent cytogenetic abnormalities

Acute myeloid leukemia with t(8;21)

  • t(8;21)(q22;q22).[3]

IHC:

  • CD34+, CD13+, MPO+ (cytoplasm), CD33+ (weak).
  • CD56+, CD117+.
    • Usu. assoc. with a bad prognosis.

Flow cytometry:

  • CD19+, PAX5+, CD79a +/-.

Acute myeloid leukemia with inv(16)

  • inv(16)(p13.1q22).[4]

Microscopic:

  • Blast count usu. ~20% (low).
  • Eosinophilic granules.
    • Used to be classified as "M4" with eosinophilia.

IHC:

  • CD2+ -- common.

Acute myeloid leukemia with t(15;17)

  • t(15;17)(q22;q12).

Comes in two flavours.

Microscopic (Hypergranular or typical APL):

  • Bean-shaped nucleus or bilobed nucleus.
  • Buddles of Auer rods - known as "Faggot cells".

Microscopic (Microgranular or hypogranular APL):

  • Bilobed nuclei with nuclear overlap. (???)
  • Absence of granules on light microscopy.

IHC:

  • CD2+, CD34+/-, CD56+/-.

Flow cytometry:

  • CD34-, HLA-DR-.
  • CD33+, CD13+/-, CD117+ (weak), CD56+/-.

Clinical:

  • Assoc. with DIC.
  • Treatment: ATRA.

Variants:

  • t(11;17) -- ATRA doesn't work.
  • t(17;17) -- ATRA doesn't work.
  • t(5;17). (???)

Acute myeloid leukemia with t(9;11)

  • t(9;11).

Microscopic:

  • Monoblastic morphology. (???)
  • Myelomonocytic morphology. (???)

Clinical:

  • +/-DIC.
  • Usu. children.

IHC:

  • CD33+, CD65+, CD4+, HLA-DR+.
  • CD34+. (???)
  • CD13+. (???)

See also

References

  1. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 314. ISBN 978-1416054542.
  2. ↑ D. Good. 21 March 2011.
  3. ↑ Berger, R. (1994). "Translocation t(8;21)(q22;q22): cytogenetics and molecular biology.". Nouv Rev Fr Hematol 36 Suppl 1: S67-9. PMID 8177719.
  4. ↑ Lu, CM.; Murata-Collins, JL.; Wang, E.; Siddiqi, I.; Lawrence, HJ. (Dec 2006). "Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: molecular evidence of two separate diseases.". Am J Hematol 81 (12): 963-8. doi:10.1002/ajh.20716. PMID 16917916.
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