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A Curious Case of Morphologically Deceptive Pediatric B-Lymphoblastic Leukemia with Granular "Blebbed" Blasts and
Sunita Sharma1, Kavita Gaur1, Tatton Perme1
1Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, Delhi, India.
Abstract:
Background: B-cell acute lymphoblastic leukemia is known for heterogeneous blast morphology. Cytoplasmic granules and blebs have both been described, but not together, in lymphoblasts. Case presentation: A 7-year-old boy presented with fever, abdominal distension for 3 weeks, with hepatosplenomegaly. Investigations revealed pancytopenia, peripheral smear showing 21% blasts of varying size, displaying cytoplasmic blebbing and granulation. Marrow aspirate was hemodilute, 10% cells showed dim to moderate expression of CD45, CD10, CD19, HLA-DR confirming B-ALL. Megakaryocytic markers (CD41, CD61) were negative. Marrow biopsy showed a focus of large atypical cells displaying increased nuclear-cytoplasmic ratio, vesicular nuclear chromatin and macronucleoli, reminiscent of diffuse large B-cell lymphoma, cells strongly expressing PAX5, CD19, CD20, and bcl-2.The child was put on standard induction therapy. No blasts were detected in subsequent peripheral smears. Conclusion: To the best of our knowledge, this is the first case of pediatric B-ALL displaying granular "blebbed" blasts.
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