PREPARED BY:

MOHD KHAIRUL AMRAN BIN MOHAMMAD Bsc. In MEDICAL LABORATORY TECHNOLOGY FACULTY OF HEALTH SCIENCE UNIVERSITY TEKNOLOGI MARA UiTM

ACUTE LYMPHOCYTIC LEUKEMIA, ALL

Description

A progressive cancer of immature lymphocytes, with primary involvement of bone marrow and blood. Acute lymphoid leukemias (ALLs) include: o Precursor lymphoblastic leukemia (20% B cell, 80% T cell) o Burkitts leukemia (100% B cell) o Adult T-cell leukemia/lymphoma (ATL) (100% T cell) Lymphoblastic lymphoma, a cancer involving bone marrow and causing a mediastinal mass, is related to T-cell ALL.

p Complete blood count presence of circulatory leukemic blast cells. The presence and severity of anemia. The count of a variety of blood cell types. Thrombocytopenia

Diagnostic procedures
Bone marrow biopsy with genetic and immunologic studies o Diagnosis of ALL requires 30% lymphoblasts in the bone marrow. Lumbar puncture, to rule out occult CNS involvement

Peripheral blood smear Precursor B-cell lymphoblastic leukemia Blasts are heterogeneous in size, have round or convoluted nuclei, have a high nuclear/cytoplasmic ratio, and lack cytoplasmic granules. ATL Leukemia cells are typical CD4+ cells with cloven hoof or flower-shaped nuclei. Burkitts leukemia Typical monotonous mass of mediumsized cells with round nuclei, multiple nucleoli, and basophilic cytoplasm with cytoplasmic vacuoles

Imaging
Not indicated

Sign and symptoms

Fever Anemia Bleeding and/or bruishing Persistent weakness or tireness Achiness in the bones or joins Recurrent infections Difficulty breathing or swollen lymph nodes

Treatment
o

Intensive induction phase Usually a combination of vincristine, prednisone, an anthracycline andcytarabine,

usually with L-asparaginase

Classification French-American-British (FAB) classification for ALL

Immunologic subtype: preB-cell ALL Immunologic subtype: T-cell ALL Immunologic subtype: B-cell ALL

CNS prophylaxis Maintenance chemotherapy that extends for about 2 years Long-term survival of 6575% of patients may be achieved. Philadelphia chromosomepositive ALL management includes imatinib. Bone marrow transplantation

L1 subtype of ALL

L2 subtype of ALL

L3 subtype of ALL

Impression:
Acute lymphocytic leukemia subtype L1

Impression:
Acute lymphocytic leukemia subtype L2

Impression:
Acute lymphocytic leukemia subtype L3

Cytologic features
Cell size small cell predominate Nuclear chromatin homogenous Nuclear shape regular Nucleoli not visible or small and inconspicuous Amount of cytoplasm scanty Basophilia of cytoplasm slightly or moderate, rarely intense Cytoplasmic vacuolation - variable

Cytologic features
Cell size large, heterogenous in size Nuclear chromatin heterogenous Nuclear shape irregular, clefting and indentation common. Nucleoli one or more present, often large Amount of cytoplasm variable, often moderately abundant Basophilia of cytoplasm variable, deep in some Cytoplasmic vacuolation - variable

Cytologic features
Cell size large, heterogenous in size Nuclear chromatin finely slippled and homogenous Nuclear shape regular, oval to round Nucleoli prominent, one or more vesicular Amount of cytoplasm moderately abundant Basophilia of cytoplasm very deep Cytoplasmic vacuolation often prominent