AML With Myelodysplasia Related Changes With APL-Like Morphology.

Area of Science:

• Hematology
• Oncology
• Cell Biology

Background:

• Faggot cells and blasts with blebs, along with intense myeloperoxidase, are characteristic morphological findings.
• Acute promyelocytic leukemia (APL) is a severe subtype of acute myeloid leukemia requiring prompt diagnosis and treatment.
• Morphological similarities can occasionally be observed in non-APL conditions, including acute leukemia with myelodysplasia-related changes.

Purpose of the Study:

• To highlight the diagnostic significance of specific morphological features in acute leukemia.
• To emphasize the urgency of initiating ATRA treatment upon suspicion of APL.
• To discuss rare presentations of non-APL with APL-like morphology.

Main Methods:

• Morphological examination of peripheral blood smears and bone marrow aspirates.
• Cytochemical staining, including myeloperoxidase.
• Review of clinical data and treatment outcomes for patients with suspected APL and similar morphologies.

Main Results:

• The presence of faggot cells, blebs on blasts, and intense myeloperoxidase activity strongly suggests APL.
• Early initiation of ATRA treatment in suspected APL cases is associated with improved outcomes.
• Rare instances of non-APL acute leukemia exhibiting these characteristic APL morphologies were identified, particularly those with myelodysplasia-related changes.

Conclusions:

• Morphological assessment remains critical for the initial diagnosis of acute leukemia subtypes.
• Prompt empirical treatment with ATRA is warranted in suspected APL to mitigate life-threatening complications.
• Awareness of rare morphological mimics is essential for accurate diagnosis and appropriate patient management in hematologic malignancies.