Difference between revisions of "Leukemia"
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IHC: | IHC: | ||
*CD2+ -- common. | *CD2+ -- common. | ||
====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 cytometery]]: | |||
*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). (???) | |||
====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== | ==See also== | ||
Revision as of 18:40, 29 May 2011
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 this article as the clear distinction between the two is historical.
Definition
All of the following:[1]
- Morphologic abnormalities.
- >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 |
| AML | larger | present | present |
| ALL | smaller | none | absent or present |
Clinical factors
Clinical are important in the classification of leukemia.
- Hx of myelodysplastic syndrome?
- Chemotherapy?
- Down syndrome?
Algorithms
There is a nice set of algorithms from D. Arber - that were presented at the 2009 USCAP.
Leukemia classification
AML:
- AML.
- AML with recurrent cytogenetic abnormalities.
- AML from MDS.
- AML in the setting of Down syndrome.
ALL:
- B cell.
- B cell with recurrent cytogenetic abnormalities.
- T cell.
AML with recurrent cytogenetic abnormalities
t(8;21)
- t(8;21)(q22;q22).[2]
IHC:
- CD34+, CD13+, MPO+ (cytoplasm), CD33+ (weak).
- CD56+, CD117+.
- Usu. assoc. with a bad prognosis.
Flow cytometry:
- CD19+, PAX5+, CD79a +/-.
inv(16)
- inv(16)(p13.1q22).[3]
- Assoc. with myeloid sarcoma.
Microscopic:
- Blast count usu. ~20% (low).
- Eosinophilic granules.
- Used to be classified as "M4" with eosinophilia.
IHC:
- CD2+ -- common.
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+/-.
- 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). (???)
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
- ↑ D. Good. 21 March 2011.
- ↑ Berger, R. (1994). "Translocation t(8;21)(q22;q22): cytogenetics and molecular biology.". Nouv Rev Fr Hematol 36 Suppl 1: S67-9. PMID 8177719.
- ↑ 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.