Case 6- Discussion

Uploaded: 2007-06-07, Updated: 2007-06-07


MICROSCOPIC EXAM:
 

PERIPHERAL BLOOD        

Severe neutropenia is present. Numerous blasts are seen. The blasts are medium size to large cells with mildly condensed to fine chromatin pattern, prominent nucleoli, increased N/C ratio, and mild amount of basophilic cytoplasm. Mild normocytic normochromic anemia is noted with mild anisopoikilocytosis and polychromasia. Few tear-drop cells and target cells are seen. Mild thrombocytopenia with unremarkable platelet morphology is noted. 

     

BONE MARROW CORE BIOPSY AND CLOT SECTION:

The overall cellularity is 95% and the cellularity ranges from 90 to 100%. Sheets of blasts comprising 90% of overall cellularity are noted. The blasts are positive for CD79a and TdT, but negative for MPO, CD3 and CD20.     

     

BONE MARROW ASPIRATE SMEAR AND TOUCH IMPRINTS:

Numerous blasts are seen, comprising about 90% of the overall cellularity. The blasts have similar features to those described in the peripheral blood. 

     

DIFFERENTIAL:

       Blasts: 90%, Promyelocytes: 1%, Myelocytes: 1%, 

       Metamyelocytes: 2%, Bands: 2%, Neutrophils: 1%, 

       Eosinophils: 1%, Lymphocytes: 1%, Plasma cells: 1%.

FLOW CYTOMETRY INTERPRETATION
 

Bone marrow: A blast population expressing CD34, TdT, CD79, CD13, CD19, CD10, CD38, and HLA-DR is present at 80% of marrow cells. This phenotype is consistent with precursor B-cell acute lymphoblastic leukemia with aberrant expression of CD13. 

                                            

     Total events       H gate Dim CD45+          A gate Bright CD45+

     analyzed = 51524   events = 44325 (89% of    events=1571 (3% of

                        totalnucleated cells)     total nucleated cells)

        CD45+/CD14-          98%                       98%

        TOTAL CD14+          <2%

        TOTAL CD13+          73%

        CD34+/CD13+          73%

        TOTAL CD15+          <2%

        CD34+/CD15+          <2%

        TOTAL CD33+          5%

        CD34+/CD33+          5%

        TOTAL CD34+          99%

        TOTAL CD11b+         17%

        TOTAL CD41+          <2%

        CD34+/CD71+          51%

        CD34+/CD117+         12%

        TOTAL HLA DR+        99%

        CD34+/HLA DR+        99%

        TOTAL CD19+          95%                      30%

        CD19+/CD20+          <2%                      29%

        CD19+/CD38+          96%                      28%

        CD19+/CD10+          87%                       3%

        CD2+/CD7+            <2%                      59%

        CD3+/CD5+            <2%                      62%

        CD3+/CD4+            <2%                      33%

        CD3+/CD8+            <2%                      29%

        CD3-/CD56+           <2%                       6%

        cCD3+                <2%

        cCD79a+              80%

        cMPO+                <2%

        nTdT+                90%

 

CYTOGENETICS (UNMC, Cytogenetics)

 

NOMENCLATURE:

48,XY,t(9;22)(q34;q11.2),+21,+der(22)t(9;22)

INTERPRETATION:

Cytogenetic analysis revealed the presence of an abnormal hyperdiploid clone characterized by t(9;22)(q34;q11.2), an extra copy of the Philadelphia chromosome, and trisomy 21.

 

FISH CYTOGENETICS REPORT:

Positive for variant BAR/ABL fusion (98%). 

INTERPRETATION: ABNORMAL. Molecular cytogenetic studies revealed the presence of the molecular rearrangement associated with the Philadelphia chromosome in 98% of the interphase nuclei from this specimen. Specifically, this patient's signal pattern was characterized by a deletion of9q34 and 22q11 along with an extra copy of the Philadelphia chromosome. These deletions cannot be visualized cytogenetically.

IMMUNOHISTOCHEMISTRY STAINS

 
CD20 CD3
CD79a MPO
 
TdT  

DIAGNOSIS

 

LYMPHOID BLAST PHASE OF CHRONIC MYELOGENEOUS LEUKEMIA

 
 
 
Clinical Futures
   
Gross Findings
   
Microscopic Findings
   
Subtypes
   
Differential Diagnosis
   
Immunohistochemistry Straining
   
Election Microscopy
   
Cytogenetics
   
Treatment and Prognosis
   
Reference