ALL

Question 1

Typical laboratory features of ALL at diagnosis include:

Answer 1

1. Leukocytosis (up to 100,000/mm3) in most cases
2. Normocytic normochromic anemia (Hb < 10g/dl)
3. Thrombocytopenia (platelet count < 50,000/mm3)

Question 2

True or false? Irrespective of the leukocyte count, Romanowsky–stained blood smears nearly always reveal some lymphoblasts (usually > 30%)

Answer 2

True

Question 3

What’s characteristic of aleukemic ALL when viewing peripheral blood?

Answer 3

No lymphoblasts are seen

Question 4

How do you detect meningeal involvement by lymphoblasts?

Answer 4

Prepare a Romanowsky stained preparation of CSF

Question 5

In ALL, the BM is often found to be _____ with almost complete replacement of normal —— by ——

Answer 5

Hypercellular, hematopoietic cells, leukemic lymphoblasts

Question 6

In ___ BM is often found to be hypercellular with almost complete replacement of normal hematopoietic cells by leukemic lymphoblasts

Answer 6

Acute lymphoblastic leukemia

Question 7

FAB classification system is based on the ___ appearance of the leukemic blasts by using ___ ___

Answer 7

Morphologic, light microscopy

Question 8

Describe ALL L1 subtype morphology

regarding size, nucleus, chromatin, cytoplasm and nucleolus

Answer 8

Size: small round blasts that are uniform in size and shape but up to 20% variation is allowed

Cytoplasm: scanty and bluish

Nucleus: regular round shape, but may have a cleft or an indentation.
This indentation is called Rieder’s deformity

Chromatin: is dense and homogenous (we don’t see thick and thin areas)

Nucleoli: cannot be seen (indistinct)

Question 9

True or false: In L1, the diagnosis is established with certainty without cytochemical reactions.

Answer 9

True

Question 10

Describe L2 blast morphology

Answer 10

1. The cell population is extremely heterogeneous and the blasts here are extremely variable in size, predominantly large
2. The volume of cytoplasm is variable, but often abundant with variable basophilia (blue to gray).
3. The nuclear shape is irregular with indentation and folding.
4. The nuclear chromatin is heterogeneous and variable, it can be very delicate or coarse.
5. One or two very distinct nucleoli are always very sharp.
6. Some lymphoblasts show what we call a hand-mirror deformity

Question 11

Describe L3 blast morphology

Answer 11

1. The cells are large and homogeneous, uniform in size
2. The nucleus is large, usually rounded or oval without indentation or clefting.
3. The chromatin is dense but finely stippled
4. One or more prominent nucleoli are visible in most cells. This is the only lymphoid
   tumor which can show up to 5 nucleoli (1-5).
5. The cells show an abundant cytoplasm which is intensely basophilic (because it is
   extremely rich in RNA) and which completely surrounds the nucleus. In addition, the cytoplasm shows intense vacuolization which is characteristic of the Burkitt cell.
   In fact, vacuoles may be seen all over the cell (Blasts are rich in neutral fats which are alcohol soluble leaving many vacuoles)

Question 12

True or false: because of the age incidence and morphological features of L2, differentiation from myeloblastic leukemia (M0/M1) can at times be quite difficult. Therefore cytochemistry is very important in these instances for confirmation.

Answer 12

True

Question 13

T/F: L2 is usually the adult type of lymphoblastic leukemia or it is the type that occurs also below 2 years of age. It constitutes ~ 70% of all lymphoblastic leukemias and its outcome is far less happy than L1

Answer 13

False —> 30%

Question 14

T/F: A low mitotic index (approximately 5%) is characteristic of L3

Answer 14

False —> high

Question 15

T/F: HLA-DR, CD19, CD10 and CD20 antigens are all B-cell specific.

Answer 15

False, they all are except for HLA-DR

Question 16

T/F: the different types of leukemias represent development arrested at different stages, as reflected in the antigens these leukemias display

Answer 16

True

Question 17

T/F: Depending on where in the pathway the cell deviates into uncontrolled growth, the ALL clone will have a characteristic pattern of antigens/markers as determined by ELISA

Answer 17

False: flow cytometry

Question 18

Expression of CD13 and CD33 suggests which type of leukemia?

Answer 18

Myeloid

Question 19

Expression of CD14 will distinguish leukemias of ____ origin?

Answer 19

Monocytic

Question 20

T/F: T-ALL cases are identified on the basis of CD2, CD5 and CD7

Answer 20

True

Question 21

Early pre-B ALL or pre pre- B ALL make up 70% cases of ALL

Answer 21

True

Question 22

T/F: L3 morphology cells have cell surface immunoglobulin expressed on their surface (usually SIgM)

Answer 22

True

Question 23

T/F: Various subtypes of acute leukemia are absolute, no hybrid cases occur.

Answer 23

False —> there can be hybrid cases

Question 24

Which immunologic type of ALL involves male predominance, a high WBC and a mediastinal mass and CNS involvement?

Answer 24

T-ALL

Question 25

Which immunologic type of ALL has positivity for HLA-DR, CD19, CD20, CD22, variability in presence of CD10 and SIgM?
Hint: TdT and CD34 negative

Answer 25

B-ALL

Question 26

Which immunologic type of ALL has L3 morphology? What are the cells called in this case?

Answer 26

B-ALL

Burkitt cells

Question 27

Which immunologic type of ALL is positive for HLA-DR, TdT, CD19, CD20 and variability in CD10? What is it characterized by?

Answer 27

Pre-B ALL

Presence of heavy chains

Question 28

Which immunologic type of ALL comprises 70% of cases?

Answer 28

Pre-pre-B ALL

Question 29

Which immunologic type of ALL is positive for HLA-DR, TdT, CD10 and CD19?

Answer 29

Pre-pre-B ALL

Question 30

Which immunologic type of ALL has mainly L2 cells?

Answer 30

Pro-B ALL

Question 31

Which immunologic type of ALL is positive for HLA-DR, TdT, CD19 and CD34?

Answer 31

Pro-B ALL

Question 32

T/F: Most patients with ALL have demonstrable karyotypic BM abnormalities

Answer 32

True