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Granular acute lymphoblastic leukemia: a case report and literature review
1Division of Pathology, City of Hope National Medical Center, Duarte, California 91010, USA.
American Journal of Hematology
|June 5, 2007
Summary
A rare granular acute lymphoblastic leukemia (ALL) case in an adult highlights diagnostic challenges. Granular ALL, common in children, mimics myeloid leukemia in adults, necessitating careful immunophenotyping to avoid misdiagnosis.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Granular acute lymphoblastic leukemia (ALL) is a rare subtype characterized by cytoplasmic granules in lymphoblasts.
- While more common in pediatric populations (2-7%), it is exceptionally rare in adults.
- Distinguishing granular ALL from myeloid differentiation is crucial to prevent misdiagnosis.
Observation:
- A 45-year-old woman with a history of multiple myeloma presented with lymphoblasts exhibiting prominent cytoplasmic granules.
- Cytochemical staining revealed positivity for acid phosphatase and Periodic Acid-Schiff, but negativity for myeloperoxidase.
- Immunophenotype analysis confirmed a precursor B-cell phenotype.
Findings:
- The patient's granular lymphoblasts mimicked myeloblasts, posing a diagnostic challenge.
- Despite granular morphology, immunophenotyping confirmed the B-cell lineage, ruling out acute myeloid leukemia.
- This case underscores the rarity and diagnostic complexities of granular ALL in adults.
Implications:
- Accurate differentiation of granular ALL from acute myeloid leukemia is critical, especially in adults.
- Immunophenotyping is essential for correct diagnosis and appropriate treatment strategies.
- Reviewing adult granular ALL cases aids in understanding this rare entity and refining diagnostic criteria.