Granular acute lymphoblastic leukemia: A case report and literature review

Pitman, Sean D.; Huang, Qin

doi:10.1002/ajh.20922

Cited by 23 publications

(13 citation statements)

References 10 publications

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“…It has been also associated with poor outcome, with remission rate of around 50%. [4] CONCLUSION This study showing rare morphological finding. It is still very important to use morphological finding in diagnosis of cases of acute leukemia.…”

Section: Discussionmentioning

confidence: 61%

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Granular lymphoblast in a case of acute lymphoblastic leukemia: A rare morphology

Mohamed¹,

Soliman²,

Yassin³

2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review

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Section: Discussionmentioning

confidence: 61%

“…It has been reported mainly with male gender, precursor B -ALL subtype same like our patient. The incidence according to literature is 2-7% and mainly during childhood [2,3] and looks like it is connected with Down syndrome [1,4]. One of the features is azurophilic cytoplasmic granules, and it is one of the defining criteria of Granular ALL.…”

Section: Discussionmentioning

confidence: 99%

Granular lymphoblast in a case of acute lymphoblastic leukemia: A rare morphology

Mohamed¹,

Soliman²,

Yassin³

2016

IJCRI

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“…One indispensable differential diagnosis is granular ALL [5,7]. Granular ALL was defined as morphological and cytogenetical ALL with more than 1% of lymphoblasts having three or more clearly defined azurophilic granules, and several reports have shown that granular ALL was not stained for MPO [5,7]. The principal discrimination between this case and granular ALL is the MPO-positive rate.…”

mentioning

confidence: 94%

“…We diagnosed the patient as having acute myeloid leukemia (M1) by the FAB classification and taking the drug sensitivity into consideration, and he might be diagnosed as acute leukemia of ambiguous lineage according to the WHO 2008 classification [6]. One indispensable differential diagnosis is granular ALL [5,7]. Granular ALL was defined as morphological and cytogenetical ALL with more than 1% of lymphoblasts having three or more clearly defined azurophilic granules, and several reports have shown that granular ALL was not stained for MPO [5,7].…”

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confidence: 99%

Myeloperoxidase-positive acute leukemia with precursor B cell immunophenotype

Kajiwara

Goto

Tanoshima

et al. 2010

Leukemia & Lymphoma

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Is it always possible to make a complete diagnosis in leukemia? It is sometimes difficult to establish a clinical diagnosis in leukemia, especially without a concordance between morphology, immunophenotype, and genetic findings. Biphenotypic cases of leukemia [1], acute myeloid leukemia (AML) with lymphoid antigen [2], acute lymphoid leukemia (ALL) with myeloid antigen [3,4], and granular ALL [5] are typical examples of such diagnostic uncertainty. Acute leukemias of ambiguous lineage in the World Health Organization (WHO) 2008 classification constitute a small population of all cases of acute leukemia [6]. These cases are considered to be heterogeneous, and are therefore difficult to classify into particular groups. We report here a case in which the patient's leukemic blasts were positively stained for myeloperoxidase (MPO), and they were classified as morphologically apparent myeloid blasts, but their immunophenotype was of pre-B cell origin. The leukemia category 'MPOpositive acute leukemia with pre-B cell immunophenotype' has not been established, and therefore clinical features, differential diagnoses, and treatment have not been completely defined. In this report, we attempt to clarify the behavior of this type of leukemia, and analyze its sensitivity to antileukemia drugs in vitro, and in vivo by monitoring the clinical course of the disease.A 16-year-old boy presented with a 1.5-month history of sternal pain, appetite loss, general malaise, and low-grade fever. Splenomegaly and supraclavicular lymphadenopathy were detected. Laboratory examination revealed leukocytosis (white blood cell count 26.1 6 10 9 /L), thrombocytopenia (platelet count 73 6 10 9 /L), and elevated lactate dehydrogenase (LDH) activity (481 U/L). Large undifferentiated blasts, some of them with rough and large azurophilic granules, occupied 91.0% and 76.5% in the bone marrow and peripheral blood, respectively [ Figures 1(A) and 1(B)]. In the bone marrow, 3.6% of blasts were cytochemically stained for MPO [ Figure 1(C)], so we diagnosed the leukemia as AML (M1) according to the French-American-British (FAB) classification. Karyotype analysis showed 46,XY, and fluorescence in situ hybridization (FISH) showed no evidence of FLT3-internal tandem duplication (ITD), BCR-ABL, and MLL rearrangement. No chimeric fusion genes were identified with multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) examination. The immunophenotype was examined by flow cytometric (FCM) analysis, and bone marrow blasts were positively stained for cytoplasmic (cy) CD79a, cyCD22, CD19, CD10, CD34, and human leukocyte antigen-DR (HLA-DR): 92.9%, 92.3%, 84.2%, 95.0%, 92.1%, and 92.2%, respectively [ Figure 1(D)]. The patient's blasts were also stained for myeloid antigens CD33 and CD66c: 73.0% and 75.8%, respectively.Next, we confirmed that these blasts were sensitive to anti-leukemia drugs in vitro, especially how the sensitivity to anti-lymphoid agents was different from the sensitivity to anti-myeloid agents. First, we calculated the absolute blast c...

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“…B lymphoblastic lymphoma/leukemia with cytoplasmic granules is seen in 2–7 % of childhood cases [1–3], but is exceedingly rare in adults. The initial finding of cytoplasmic granules in blasts may lead to improper triage of ancillary studies, such as molecular or fluorescence in situ hybridization, when relying on histologic examination alone.…”

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confidence: 99%