acute leukemias 2-csbrp
TRANSCRIPT
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Acute Lymphoblastic Acute Lymphoblastic leukemias - leukemias - ALLALL
Dr.CSBR.Prasad, M.D.
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What is leukemia?
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Name the two main types of acute leuemias?
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Name the two popular classifications used in acute
leukemias?
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What is the required blast percentage for the diagnosis of
acute leukemia?
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When do you clinically suspect acute leukemia?
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Name the stains used to differentiate AML from ALL?
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How WHO classification differs from FAB classification of acute
leukemias?
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ALL
The acute lymphoblastic leukemias (ALLs) are systemic neoplastic proliferations of lymphoblasts that have their origin in a bone marrow lymphocyte progenitor cell.
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ALL
• Disease of the children and young adults
• With a peak incidence at 4yrs of age• The most common childhood
leukemia (80%)• More common in boys • It can occur in adults (less frequent)
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ALLClassification: FAB (Morphological, immunological)
• Divided in to 3 types ALL L1, L2 & L3• L1 is most common in children (85%)• L2 is common in adults• 80% of ALLs are of B-cell origin (CD 19)
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FAB classificationFAB classificationo L1: small cells predominate 2x the dia of
small lymphocyte, Nuclei round regular, occasional cleft. Nucleoli not visible. Cytoplasm is scanty. Homogeneous population
o L2: heterogeneous in size, share features of L1 & L3. Nuclei show clefts, Nucleoli+
o L3: homogeneous population of large cells, 3-4x dia of small lymphocytes, nuclei are round, oval with prominent nucleoli. Cytoplasm abundant deeply basophilic, Vacuolated.
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ACUTE LYMPHOBLASTICLEUKEMIA, L1 (ALL-L1)
L1: small cells predominate 2x the dia of small lymphocyte, Nuclei round regular, occasional cleft. Nucleoli not visible. Cytoplasm is scanty. Homogeneous population
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Name the stains employed to distinguish AML from ALL?
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PAS – Block positivity
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IMMUNOPEROXIDASE STAIN FOR TdT ON A BONE MARROW SMEAR FROM A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA
The nuclear distribution of the stain corresponds to the location of TdT in the lymphoblasts.
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ALL L1 Bone marrow
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ALL L2: Heterogeneous in size, share features of L1 & L3. Nuclei show clefts,
Nucleoli+
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ACUTE LYMPHOBLASTIC LEUKEMIA, L2 (ALL-L2)The lymphoblasts vary in size, have reticular chromatin, prominent nucleoli, and lack the nuclear irregularity of the blasts. A minority of the lymphoblasts have the cytologic features of ALL-L1. (Wright-Giemsa stain)
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ALL - L3: Homogeneous population of large cells3-4x dia of small lymphocytesNuclei are round, oval with prominent nucleoliCytoplasm abundant deeply basophilic, vacuolated
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ALL L3 Burkitt’s leukemia
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ALL L3 Burkitt’s leukemia
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ALL L3 A methyl green pyronine (MGP) stain on the left shows strong uniform staining of the cytoplasm. On the right the cytoplasmic vacuoles stain with oil red 0.
MGP Oil red O
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Chromosomal changes
1. Hyperdiploidy: upto 60 chr. Good prognosis
2. Ph’ L2 Poor prognosis3. t(1,19) pre-B ALL, Poor prognosis4. t(8,14) L3, Poor prognosis
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Specific CFThe presenting signs and symptoms are similar to
those of AML and are usually related to blood cytopenias.
Lethargy, malaise, fever, and infection are the most common.
T-cell ALL : Mediastinal mass, Testis is involvedALL 3 (Burkitt’s): Maxilla is involved
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Denis Burkitt
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Aplastic Presentation of ALL
Rarely, patients with ALL present with pancytopenia and a hypoplastic bone marrow. Leukemic blasts may not be identified initially. This hypocellular phase is typically followed by apparent bone marrow recovery and later by overt leukemia in a matter of weeks or a few months.
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Some terms
1- Aleukemic leukemia2- Sub leukemic leukemia3- Leukemoid reaction
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CYTOLOGIC FEATURES OF BLASTS IN ACUTE MYELOID & ACUTE LYMPHOBLASTIC LEUKEMIAS
AMLAML ALLALLBlast sizeBlast size Medium to large, uniform Variable Small to
medium
CytoplasmCytoplasm Fine granules may be present
Usually scant, a few coarse granules may be seen
Auer rodsAuer rods Present in 60-70% of cases absent
Nuclear chromatin Nuclear chromatin Finely dispersed Fine to coarse
NucleoliNucleoli 2-4, prominent 1-3, indistinct
Other cell typesOther cell types Often dysplastic changes in maturing myeloid cells
Myeloid cells are not dysplastic
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