Page 145 - Haematologica Atlas of Hematologic Cytology

CHAPTER 16 - Precursor lymphoid neoplasms
Figure lymphoblastic leu emia with t( ) ( 4 1 1 1 1 11 ) BCR-ABL1 Peripheral blood film Conspicuous leukocytosis is is evident at low ma- gnification (white blood cell count 109x109/L) almost all cells appear to be blasts Figure 4 4 lymphoblastic leu emia with t( ) ) ( ( 4 4 1 1 1 1 11 ) ) BCR-ABL1 Peripheral blood film as as in in Figure 3 At higher magnification circula- ting blasts have small to to medium size high high nucle- ar:cytoplasmic ratio rather condensed chroma- tin tin and and inconspicuous nucleoli irregular nuclear shape with clefting and and indentation Immunophe- notyping showed a a a a a a precursor B phenotype in- termediate stage (common) ( ( HLA-DR+ CD19+ is is associated with a a a a a a poor prognosis Figure lymphoblastic leu emia with t( ) ( 4 1 1 1 1 11 ) BCR-ABL1 Cerebrospinal fluid The cytospin shows many blasts in in in a a a a case with menin- geal involvement This leukemia entity usually presents with very high white blood cell count and frequent meningeal involvement Leukemic cells show intrinsic resistance to chemotherapy but treatment with tyrosine kinase inhibitors may have a a a a a significantly favourable effect on outco- me CD CD CD CD10+ TdT+) Many blasts were positive also for CD34 and expressed the “multidrug resistance” glycoprotein P-170 Karyotype showed t(9 22) (q34 1 1 1 1 1 1 1 1 q11 q11 2) 2) and and DNA analysis rearrangement of of BCR BCR at at 22q11 2 2 2 2 and and ABL1 ABL1 at at 9q34 1 1 1 1 1 1 1 1 with pro- duction of of of a a a a a a a BCR-ABL1 fusion protein This gene- tic abnormality is is found in in in 15-25% of of of of adult ALL ALL cases cases and and in in 2-5% of of of cases cases of of of childhood ALL ALL and and it it it 132