Acute lymphoblastic leukemia of Burkitt's type (L-3 ALL) lacking surface immunoglobulin and the 8;14 translocation

A 25-year-old man developed acute lymphoblastic leukemia, morphologically of Burkitt's type (L3-ALL, F.A.B. classification) but with immunologic and cytogenetic features not previously reported. The leukemic blasts were B1+, CALLA+, OKT3-, and OKT11-. Surface immunoglobulin and cytoplasmic IgM were not detected, but cytoplasmic IgG lambda was present. Karyotypic analysis of 20 metaphases was normal at presentation but abnormal after relapse. At that time, the predominant karyotype was 47XY, 1q-, 7q-, 12p-, M1. This case illustrates the following: (1) Burkitt cell morphology may accompany some uncommon pre-B-cell lymphoblastic leukemias, and (2) rearrangements involving chromosomes 14, 2 or 22 may not be found in all cases of L-3 ALL.