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Case Reports
. 2022 Jul 31;9(1):100045.
doi: 10.1016/j.acpath.2022.100045. eCollection 2022.

Educational Case: Diagnostic studies for B-cell acute lymphoblastic leukemia

David T Danielson  1 , Nena C Wendzel  2 , Barbara Knollmann-Ritschel  1   3 , Jeannie M Muir  1   3
Affiliations
Case Reports

Educational Case: Diagnostic studies for B-cell acute lymphoblastic leukemia

David T Danielson et al. Acad Pathol. .
No abstract available

Keywords: Diagnostic medicine; Flow cytometry; Leukemia; Molecular diagnostics; Obtaining a specimen; Pathology competencies; Special studies; Surgical pathology.

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Figures

Fig. 1
Fig. 1
Peripheral Blood. (A) Peripheral blood smear at 400x. Large immature cells are present. RBCs are normochromic in appearance with anisocytosis appreciable. (B) Peripheral blood smear at 1000x. Immature cells are appreciated with characteristic partially condensed chromatin, high nuclear to cytoplasmic ratio, and scant non-granular cytoplasm. There are normal red blood cells in the background. RBC, red blood cells.
Fig. 2
Fig. 2
Bone marrow aspirate. (A) A smear of bone marrow aspirate at 400x. Immature appearing cells are present and make up the majority of the cell count with occasional erythroid precursors and granulocyte precursors appreciated. A megakaryocyte can be appreciated in the upper right portion of the image (arrow). (B) Smear of bone marrow aspirate at 1000x. Cells with characteristic partially condensed chromatin and scant lightly basophilic cytoplasm make up the majority of the cells. Granulocyte precursors are seen, such as the eosinophilic band on the upper part of the slide (arrow). Erythroid precursors and erythrocytes are present (arrowhead).
Fig. 3
Fig. 3
Bone marrow core biopsy. (A) Bone marrow core biopsy 40x. Trabecular bone is appreciated. Bone marrow is hypercellular in appearance. Trilineage hematopoiesis is markedly reduced and difficult to appreciate due to the monomorphic population of immature cells. (B) Bone marrow core biopsy 400x. Monomorphic immature cells make up the majority of the cells appreciated. Cells of erythroid (arrow head) and myeloid lineage (arrow) are appreciable but at decreased percentages from what would be expected, similar to what was seen in the bone marrow aspirate.
Fig. 4
Fig. 4
Flow cytometry analysis of patient's bone marrow aspirate. (A) CD45 vs SSC. Blast gate is assigned to the population of cells with positive CD45 and minimal side scatter. (B) Negative staining for MPO and positive staining for TdT. (C) Positive staining for CD34 and CD19. (D) Positive staining for CD34 and CD79a. (E) Positive staining for CD10 partially positive (dim intensity) staining for CD20. (F) Positive staining for HLA-DR and CD34. MPO, myeloperoxidase; SSC, side scatter; TdT, terminal deoxynucleotidyl transferase.
Fig. 5
Fig. 5
Immunohistochemical staining of the core biopsy taken from the patient's bone marrow. (A) Staining for CD19 at 400x shows a positive membranous staining pattern. (B) Staining for CD34 at 400x shows positive membranous/cytoplasmic staining. (C) Staining for CD79a at 400x shows positive membranous staining. (D) Staining for TdT at 400x shows positive nuclear staining. TdT, terminal deoxynucleotidyl transferase.
See this image and copyright information in PMC

References

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