Difference between revisions of "Acute myeloid leukemia"

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#redirect [[Leukemia#Acute_myeloid_leukemia]]
Abbreviated ''[[AML]]''.


[[Category:Diagnosis]]
===General===
*Adults.
 
Exclusions for this diagnosis:
*Prior [[MDS]].
*[[Down syndrome]].
 
===Microscopic===
Features:
*[[Auer rods]] present
*Cytoplasmic granularity.
*Large cells.
 
Note:
*May be classified by morphology, using the (old) French-American-British (FAB) classification (M0-M7).
 
====Image====
<gallery>
Image:Auer_rods.PNG | Auer rods in an AML. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case344.html AML - several images (upmc.edu)].
 
===Molecular===
*Must exclude all the recurrent cytogenetic abnormalities - see below.
 
==AML with recurrent cytogenetic abnormalities==
===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>
 
IHC:
*CD34+, CD13+, MPO+ (cytoplasm), CD33+ (weak).
*[[CD56]]+, CD117+.
**Usu. assoc. with a bad prognosis.
 
Flow cytometry:
*CD19+, PAX5+, CD79a +/-.
 
Images:
*[http://path.upmc.edu/cases/case712.html AML with t(8;21) (upmc.edu)].
 
===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 }}
</ref>
 
*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)===
*[[AKA]] ''acute promyelocytic leukemia''
**Abbreviated ''APL''.
*t(15;17)(q22;q12).
**Fusion transcripts: PML<ref name=omim102578>{{OMIM|102578}}</ref>-RARA.<ref name=omim180240>{{OMIM|180240}}</ref>
 
====General====
Clinical:
*Associated with [[DIC]].
*Treatment: all-trans retinoic acid (ATRA).
 
Variants:
*t(11;17) -- ATRA doesn't work.<ref>{{Ref APBR|623 Q2}}</ref>
*t(17;17) -- ATRA doesn't work.
*t(5;17). (???)
 
====Microscopic====
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.
 
=====Images=====
<gallery>
Image:Faggot cell in AML-M3.jpg |Faggot cell in AML-M3. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case457/images/fig01.jpg AML - showing Auer rods (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case457.html http://path.upmc.edu/cases/case457.html]. Accessed on: 21 January 2012.</ref>
*[http://path.upmc.edu/cases/case705.html APML - several images (upmc.edu)].
 
====IHC====
*CD2 +ve, CD34 +ve/-ve, CD56 +ve/-ve.
 
====[[Flow cytometry]]====
*CD34 -ve, HLA-DR -ve.
*CD33 +ve, CD13 +ve/-ve, CD117 +ve (weak), CD56 +ve/-ve.
 
===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+. (???)
 
[[Category: Hematopathology]]

Revision as of 18:48, 26 May 2018

Abbreviated AML.

General

  • Adults.

Exclusions for this diagnosis:

Microscopic

Features:

  • Auer rods present
  • Cytoplasmic granularity.
  • Large cells.

Note:

  • May be classified by morphology, using the (old) French-American-British (FAB) classification (M0-M7).

Image

  • Auer rods in an AML. (WC)

www:

Molecular

  • Must exclude all the recurrent cytogenetic abnormalities - see below.

AML with recurrent cytogenetic abnormalities

Acute myeloid leukemia with t(8;21)

  • t(8;21)(q22;q22).[1]

IHC:

  • CD34+, CD13+, MPO+ (cytoplasm), CD33+ (weak).
  • CD56+, CD117+.
    • Usu. assoc. with a bad prognosis.

Flow cytometry:

  • CD19+, PAX5+, CD79a +/-.

Images:

Acute myeloid leukemia with inv(16)

  • inv(16)(p13.1q22).[2]

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)

  • AKA acute promyelocytic leukemia
    • Abbreviated APL.
  • t(15;17)(q22;q12).
    • Fusion transcripts: PML[3]-RARA.[4]

General

Clinical:

  • Associated with DIC.
  • Treatment: all-trans retinoic acid (ATRA).

Variants:

  • t(11;17) -- ATRA doesn't work.[5]
  • t(17;17) -- ATRA doesn't work.
  • t(5;17). (???)

Microscopic

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.
Images

  • Faggot cell in AML-M3. (WC)

www:

IHC

  • CD2 +ve, CD34 +ve/-ve, CD56 +ve/-ve.

Flow cytometry

  • CD34 -ve, HLA-DR -ve.
  • CD33 +ve, CD13 +ve/-ve, CD117 +ve (weak), CD56 +ve/-ve.

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+. (???)
  1. ↑ Berger, R. (1994). "Translocation t(8;21)(q22;q22): cytogenetics and molecular biology.". Nouv Rev Fr Hematol 36 Suppl 1: S67-9. PMID 8177719.
  2. ↑ 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.
  3. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 102578
  4. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 180240
  5. ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 623 Q2. ISBN 978-1416025887.
  6. ↑ URL: http://path.upmc.edu/cases/case457.html. Accessed on: 21 January 2012.
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