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[Two cases of acute lymphoblastic leukemia with cytoplasmic granules]
Shiho Morita1, Katsuyasu Saigo, Yoshiyuki Kosaka
1Blood Transfusion Division, Kobe University Hospital, Kobe 650-0017.
Insights
Cytoplasmic granules in acute lymphoblastic leukemia (ALL) can be mistaken for myeloid leukemia markers. Accurate diagnosis requires recognizing granular ALL, distinguishing it from myeloid types through advanced cell analysis.
Area of Science:
- Hematology
- Oncology
- Cell Biology
Background:
- Cytoplasmic granules in blastoid cells are typically used to differentiate myeloid leukemia from lymphoblastic leukemia.
- Acute lymphoblastic leukemia (ALL) is a heterogeneous group of lymphoid malignancies.
Observation:
- Two cases of acute lymphoblastic leukemia (ALL) presented with cytoplasmic granulation.
- Leukemic cells were positive for CD10, 19, 20, 33, 34, and HLA-DR surface markers.
- Electron microscopy revealed no myeloperoxidase activity in the granules.
Findings:
- Immunoglobulin gene rearrangement confirmed B-precursor ALL in both patients.
- The observed granules were identified as likely autophagolysosomes, not myeloid markers.
- This indicates a subset of ALL can exhibit granulation.
Implications:
- Accurate differential diagnosis of acute leukemias requires recognizing granular ALL.
- This finding challenges the traditional view of cytoplasmic granules as exclusive myeloid markers.
- Further research into the mechanisms and clinical significance of granular ALL is warranted.
Abstract:
The presence of cytoplasmic granules in blastoid cells of patients with acute leukemia is generally accepted as a useful morphological marker for differentiation of myeloid leukemia from lymphoblastic leukemia. We diagnosed two cases of acute lymphoblastic leukemia(ALL) with cytoplasmic granulation. Surface marker analysis of leukemic cells revealed they were positive for CD10, 19, 20, 33, 34 and HLA-DR. Immunoglobulin gene rearrangement was detected by means of Southern hybridization with an Ig-JH probe for both patients. On the basis of these findings, the patients were diagnosed as having B-precursor ALL. Electron microscopic observation showed no myeloperoxidase activity, so that the granules were considered to be related to autophagolysosomes. This experience demonstrates that the recognition of the presence of granular ALL is necessary for making an accurate differential diagnosis of acute leukemias.
