Immunophenotypic and molecular features of 'cuplike' acute myeloid leukemias
Paola Carluccio1, Anna Mestice, Domenico Pastore
1Department of Emergency - Section of Haematology, University of Bari, Bari, Italy.
Abstract:
Nuclear invaginations, also referred to as fishmouth or cuplike nuclei, have long been identified in microgranular APL, myelomonocytic and monocytic AMLs. More recently, this typical morphological feature has been associated with NPM1 and FLT3 mutations, as well as with the lack of CD34 and HLA-DR expression. In this study, we retrospectively analyzed the morphologic, immunophenotypic, cytogenetic, and molecular features of 68 patients with AML. A cuplike nuclear invagination was detected in more than 10% of blast cells in 15 (22%) cases. Our data show that a cuplike morphology is associated with FLT3-ITD positivity, as well as with the loss of CD34 and HLA-DR expression. The results were not significantly modified when a higher cutoff of cuplike cells was used. Our results are not sufficient to suggest that cuplike AML could represent a distinct subtype, but further investigations could yield a better characterization of this feature in patients with AML.
Insights
Cuplike nuclear invaginations in acute myeloid leukemia (AML) are linked to specific mutations and cell markers. This morphological feature, observed in 22% of patients, correlates with FLT3-ITD positivity and loss of CD34/HLA-DR.
Area of Science:
- Hematology
- Oncology
- Cell Biology
Background:
- Nuclear invaginations, or cuplike nuclei, are recognized morphological features in certain subtypes of acute myeloid leukemia (AML).
- These features have been recently associated with specific genetic mutations (NPM1, FLT3) and immunophenotypic markers (lack of CD34, HLA-DR expression).
Purpose of the Study:
- To investigate the association between cuplike nuclear morphology and other clinicopathological, immunophenotypic, and molecular features in a cohort of AML patients.
- To determine if cuplike morphology could serve as a potential diagnostic or prognostic indicator in AML.
Main Methods:
- Retrospective analysis of 68 AML patients.
- Evaluation of morphologic features (cuplike nuclei), immunophenotypic markers (CD34, HLA-DR), cytogenetic data, and molecular mutations (FLT3-ITD).
Main Results:
- Cuplike nuclear invaginations were detected in over 10% of blast cells in 22% of the analyzed AML cases.
- A significant association was found between cuplike morphology and FLT3-ITD positivity.
- Loss of CD34 and HLA-DR expression was also correlated with the presence of cuplike nuclear invaginations.
Conclusions:
- Cuplike nuclear morphology in AML is associated with FLT3-ITD mutations and the absence of CD34 and HLA-DR expression.
- While not sufficient to define a distinct AML subtype, cuplike morphology warrants further investigation for its potential role in AML characterization and prognosis.
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