Difference between revisions of "Leukemia"
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==Leukemia classification== | ==Leukemia classification== | ||
AML: | Acute myeloid leukemia (AML): | ||
#AML. | #AML. | ||
#AML with recurrent cytogenetic abnormalities. | #AML with recurrent cytogenetic abnormalities. | ||
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#AML in the setting of Down syndrome. | #AML in the setting of Down syndrome. | ||
ALL: | Acute lymphoid leukemia (ALL): | ||
#B cell. | #B cell. | ||
#B cell with recurrent cytogenetic abnormalities. | #B cell with recurrent cytogenetic abnormalities. | ||
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===AML with recurrent cytogenetic abnormalities=== | ===AML with recurrent cytogenetic abnormalities=== | ||
====t(8;21)==== | ====Acute myeloid leukemia with t(8;21)==== | ||
*t(8;21)(q22;q22).<ref>{{Cite journal | last1 = Berger | first1 = R. | title = Translocation t(8;21)(q22;q22): cytogenetics and molecular biology. | journal = Nouv Rev Fr Hematol | volume = 36 Suppl 1 | issue = | pages = S67-9 | month = | year = 1994 | doi = | PMID = 8177719 }}</ref> | *t(8;21)(q22;q22).<ref>{{Cite journal | last1 = Berger | first1 = R. | title = Translocation t(8;21)(q22;q22): cytogenetics and molecular biology. | journal = Nouv Rev Fr Hematol | volume = 36 Suppl 1 | issue = | pages = S67-9 | month = | year = 1994 | doi = | PMID = 8177719 }}</ref> | ||
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*CD19+, PAX5+, CD79a +/-. | *CD19+, PAX5+, CD79a +/-. | ||
====inv(16)==== | ====Acute myeloid leukemia with inv(16)==== | ||
*inv(16)(p13.1q22).<ref name=pmid16917916>{{Cite journal | last1 = Lu | first1 = CM. | last2 = Murata-Collins | first2 = JL. | last3 = Wang | first3 = E. | last4 = Siddiqi | first4 = I. | last5 = Lawrence | first5 = HJ. | title = Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: molecular evidence of two separate diseases. | journal = Am J Hematol | volume = 81 | issue = 12 | pages = 963-8 | month = Dec | year = 2006 | doi = 10.1002/ajh.20716 | PMID = 16917916 }} | *inv(16)(p13.1q22).<ref name=pmid16917916>{{Cite journal | last1 = Lu | first1 = CM. | last2 = Murata-Collins | first2 = JL. | last3 = Wang | first3 = E. | last4 = Siddiqi | first4 = I. | last5 = Lawrence | first5 = HJ. | title = Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: molecular evidence of two separate diseases. | journal = Am J Hematol | volume = 81 | issue = 12 | pages = 963-8 | month = Dec | year = 2006 | doi = 10.1002/ajh.20716 | PMID = 16917916 }} | ||
</ref> | </ref> | ||
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*CD2+ -- common. | *CD2+ -- common. | ||
====t(15;17)==== | ====Acute myeloid leukemia with t(15;17)==== | ||
*t(15;17)(q22;q12). | *t(15;17)(q22;q12). | ||
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*t(5;17). (???) | *t(5;17). (???) | ||
====t(9;11)==== | ====Acute myeloid leukemia with t(9;11)==== | ||
*t(9;11). | *t(9;11). | ||
Revision as of 15:19, 8 January 2012
The article addresses leukemia, which is uncommonly seen by anatomical pathologists. It is a subset of hematopathology.
Lymphoma is discussed in the lymphoma article, and overlaps somewhat with leukemia as the clear distinction between the two is historical (see below).
Historical classification:[1]
- Leukemia = involves bone marrow +/- peripheral blood.
- Classic presentation: infection, bleeding, anemia.
- Lymphoma = discrete mass(es), usu. lymph node.
- Classic presentation: non-tender lymph nodes
Definition
All of the following:[2]
- Morphologic abnormalities.
- >20% blasts or recurrent cytogenetic abnormality.
Some recurrent cytogenetic abnormalities:
- t(8;21).
- inv(16).
- t(15;17).
Histomorphologic overview
| Disease/Feature | Blast size | Auer rods | Granulation of cytoplasm |
| AML | larger | present | present |
| ALL | smaller | none | absent or present |
Clinical factors
Clinical are important in the classification of leukemia.
- Hx of myelodysplastic syndrome?
- Chemotherapy?
- Down syndrome?
Algorithms
There is a nice set of algorithms from D. Arber - that were presented at the 2009 USCAP.
Leukemia classification
Acute myeloid leukemia (AML):
- AML.
- AML with recurrent cytogenetic abnormalities.
- AML from MDS.
- AML in the setting of Down syndrome.
Acute lymphoid leukemia (ALL):
- B cell.
- B cell with recurrent cytogenetic abnormalities.
- T cell.
AML with recurrent cytogenetic abnormalities
Acute myeloid leukemia with t(8;21)
- t(8;21)(q22;q22).[3]
IHC:
- CD34+, CD13+, MPO+ (cytoplasm), CD33+ (weak).
- CD56+, CD117+.
- Usu. assoc. with a bad prognosis.
Flow cytometry:
- CD19+, PAX5+, CD79a +/-.
Acute myeloid leukemia with inv(16)
- inv(16)(p13.1q22).[4]
- Associated with myeloid sarcoma.
Microscopic:
- Blast count usu. ~20% (low).
- Eosinophilic granules.
- Used to be classified as "M4" with eosinophilia.
IHC:
- CD2+ -- common.
Acute myeloid leukemia with t(15;17)
- t(15;17)(q22;q12).
Comes in two flavours.
Microscopic (Hypergranular or typical APL):
- Bean-shaped nucleus or bilobed nucleus.
- Buddles of Auer rods - known as "Faggot cells".
Microscopic (Microgranular or hypogranular APL):
- Bilobed nuclei with nuclear overlap. (???)
- Absence of granules on light microscopy.
IHC:
- CD2+, CD34+/-, CD56+/-.
- CD34-, HLA-DR-.
- CD33+, CD13+/-, CD117+ (weak), CD56+/-.
Clinical:
- Assoc. with DIC.
- Treatment: ATRA.
Variants:
- t(11;17) -- ATRA doesn't work.
- t(17;17) -- ATRA doesn't work.
- t(5;17). (???)
Acute myeloid leukemia with t(9;11)
- t(9;11).
Microscopic:
- Monoblastic morphology. (???)
- Myelomonocytic morphology. (???)
Clinical:
- +/-DIC.
- Usu. children.
IHC:
- CD33+, CD65+, CD4+, HLA-DR+.
- CD34+. (???)
- CD13+. (???)
See also
References
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 314. ISBN 978-1416054542.
- ↑ D. Good. 21 March 2011.
- ↑ Berger, R. (1994). "Translocation t(8;21)(q22;q22): cytogenetics and molecular biology.". Nouv Rev Fr Hematol 36 Suppl 1: S67-9. PMID 8177719.
- ↑ Lu, CM.; Murata-Collins, JL.; Wang, E.; Siddiqi, I.; Lawrence, HJ. (Dec 2006). "Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: molecular evidence of two separate diseases.". Am J Hematol 81 (12): 963-8. doi:10.1002/ajh.20716. PMID 16917916.