ACUTE LYMPHOBLASTIC LEUKEMIAS Flashcards
are often associated with this syndrome
Prodromal or preleukemic symptoms
CLINICAL MANIFESTATIONS
Pancytopenia Malaise, fatigue and pallor Bone and joint pains Cranial nerve paralysis Increased ICP Fundic (eye) hemorrhages Meningeal infiltration signs Lymphadenopathy and hepatosplenomegaly
LABORATORY FINDINGS
Total WBC count is
elevated
(>10 X 109/L) – 60%;
markedly elevated (>100) – 15%;
leukepenic
(
LABORATORY FINDINGS
BM:
Fibrosis:
(+) leukemic lymphoblast in smears
hypercellular and infiltrated
10-15%
Thrombocytopenia
Anemia
Should be differentiated with:
PERTUSSIS – lymphoid leukocytosis
INFECTIOUS LYMPHOCYTOSIS
INFECTIOUS MONONUCLEOSIS –
autoimmune anemia and thrombocytosis; (+) heterophil antibody
TYPE L1:
TYPE L2:
TYPE L3:
Small cell, Homogenous
Large cell, Heterogenous
Burkitt Type
L1
Cell size - Chromatin - Nuclear shape - Nucleoli - Amount of cytoplasm - Basophilia of cytoplasm - Cytoplasmic vacuolization -
- Small
- Homogenous
- Regular with occ clefting and indentation
- Not visible, small or inconspicuous
- Scanty
- Slight or moderate; rarely intense
- Variable
L2
Cell size - Chromatin - Nuclear shape - Nucleoli - Amount of cytoplasm - Basophilia of cytoplasm - Cytoplasmic vacuolization -
Large, heterogenous
Variable; heterogenous
Irregular
Clefting and indentation common
One or more present; often large
Variable, often mod abundant
Variable, deep in some
Variable
L3
Cell size - Chromatin - Nuclear shape - Nucleoli - Amount of cytoplasm - Basophilia of cytoplasm - Cytoplasmic vacuolization -
Large, homogenous
Finely stippled; Homogenous
Regular
Round to oval
Prominent; one or more vesicular
Moderately abundant
Very deep
Often prominent
ALL are negative
MYELOPEROXIDASE or SUDAN BLACK
PAS
significant between L1 and L2; L1 is strongly positive
ACID PHOSPHATASE
Golgi region
Diffuse pattern in
positive for all ALL
is (+) for T-cell type
myeloid cells
NSE
focal positivity in T-cells
Useful in M5 VS L2 (M5 cytoplasm is diffusely stained)
an intranuclear enzyme that catalyzes the addition of deoxynucleotides to the 3’ hydroxy end of oligonucleotides or polynucleotides without the use of templates
TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE (TdT)
TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE (TdT)
Activity (+)
Strong activity in
Useful in
– thymocytes, primitive lymphocytes
Strong activity in ALL
Useful in CML’s lymphoblastic transformation
