Page 149 - Haematologica Atlas of Hematologic Cytology

CHAPTER 16 - Precursor lymphoid neoplasms
Figure 14 Lymphoblastic leu emia granular variant Peripheral blood film from a a a a 29-ye- ar-old female presenting with severe anemia thrombocytopenia and leukocytosis showing me- dium-sized blasts with round nuclei rather con- densed chromatin prominent nucleolus (blast at at the bottom) blue cytoplasm with numerous co- arse azurophilic granules Figure 1 Lymphoblastic leu emia granular va- riant Bone marrow smear from the same case as as Figure 14 showing blasts with large purple granu- les les Granules were negative for Sudan black and peroxidase reactions and they did not stain me- tachromatically with toluidine blue Immunophe- notyping indicated the diagnosis of B-lineage intermediate stage (common) lymphoblastic leu- kemia Karyotyping revealed hyperdiploidy with trisomy 8 Acute lymphoblastic leukemia with cytoplasmic granules or inclusions is an an unusual morphological variant of acute leukemia: large granules containing vesicles usually membrane bound are demonstrable by ultrastructural inve- stigation The biological and clinical significance of this variant is is still obscure Figure 1 Lymphoblastic leu emia with hand mirror cells Bone marrow smear showing small blasts with eccentric round or oval nucleus and an an an asymmetrical cytoplasmic projection This
variant is more frequent in adults with a a a a a fema- le predominance It usually shows an an early B-cell phenotype and its clinical course is relatively in- dolent even despite the failure to achieve a a a com- plete remission 136