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Published on: February 21, 2018
Hypergranular precursor B-cell acute lymphoblastic leukemia in a 16-year-old boy
Prashant R Tembhare1, P G Subramanian, Kunal Sehgal
1Department of Pathology, Tata Memorial Center, Mumbai, India. docprt@gmail.com
Indian Journal of Pathology & Microbiology
|August 15, 2009
Summary
Hypergranular acute lymphoblastic leukemia (ALL) is rare and can mimic acute myeloid leukemia due to cytoplasmic granules. Comprehensive immunophenotyping is crucial for accurate diagnosis of this ALL subtype.
Area of Science:
- Hematology
- Oncology
- Immunophenotyping
Background:
- Cytoplasmic granules in blasts are characteristic of myeloid leukemia.
- Acute lymphoblastic leukemia (ALL) with numerous cytoplasmic granules is rare and may be misdiagnosed.
Observation:
- A case of hypergranular precursor B-cell ALL in an adolescent male is presented.
- Blasts expressed CD10, CD19, CytoCD22, CD34, CD13, and CD117.
- Cytochemical stains were negative for myeloperoxidase (MPO) and acid phosphatase (ACP), but positive for non-specific esterase (NSE).
Findings:
- The hypergranular morphology and mixed immunophenotype (B-cell ALL markers with myeloid markers CD13 and CD117) presented a diagnostic challenge.
- Cytochemical negativity for MPO and positivity for NSE further complicated lineage determination.
Implications:
- This case highlights the importance of recognizing hypergranular ALL as a rare entity.
- Comprehensive immunophenotypic analysis with a broad antibody panel is essential to avoid misdiagnosis, especially in centers with limited antibody usage.
- Accurate diagnosis is critical for appropriate treatment and patient management.
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