Page 147 - Haematologica Atlas of Hematologic Cytology

CHAPTER 16 - Precursor lymphoid neoplasms
Figure lymphoblastic leu emia/lympho- ma with t( 14)( 1 1 1 1 1 1 1 1 1) IGH/IL3 Periphe- ral blood film from a a a 7-year-old boy presenting a a a diffuse skin rash Most circulating cells (WBC 40x109/L) are mature eosinophils even hypogra- nular and pseudo-Pelger Note that as often hap- pens the yellow color of eosinophilic granules is poorly reproduced in in this photograph as in in Figu- re 10 and 11 Figure 10 lymphoblastic leu emia/lymphoma with t( 14)( 1 1 1 1 1 1 1 1 1) IGH/IL3 Bone marrow smear showing a a a few erythroblasts neutrophilic and and eosinophilic precursors and and blast cells Blasts were peroxidase negative and expressed a a a a B-li- neage intermediate (common) phenotype: they were positive for CD19 CD20 CD10 CD79a and TdT and and negative for myeloid and and T-cell markers Karyotyping showed t(5 14)(q31 1 1 1 1 q32 1) This ab- normality results in a a a a a functional rearrangement between the IL3 gene on chromosome 5 and an an IGH gene on on chromosome 14 determining consti- tutive overexpression of IL3 and variable reactive eosinophilia Eosinophilia may precede the deve- lopment of of ALL or the onset of of relapse Figure 11 lymphoblastic leu emia/lymphoma with t( 14)( 1 1 1 1 1 1 1 1 1) IGH/IL3 Cerebrospinal fluid cytospin from a a 15-year-old boy previously treated for common ALL readmitted with heada- che Complete blood count was normal with 3% eosinophils Cerebrospinal fluid cell count was 600/ml On cytocentrifuged preparations many eosinophils are observed moreover blast cells are present together with some basophils lym- phocytes and a a a monocyte In this case of lympho- blastic leukemia relapse lymphoblast infiltration of the meninges developed with eosinophil infil- tration at at the the same site in the the absence of peri- pheral hypereosinophilia 134