Histopathology of Leukemia

Types of Leukemia
There are 4 main type of leukemia

Acute Lymphoblastic Leukemia (ALL):
This is the most common type of leukemia in young children. ALL can also
occurs in adults.
Acute Myelogenous Leukemia (AML):
AML is a common type of leukemia. It occurs in children and adults.
AML is the most common type of acute leukemia in adults.
Chronic Lymphocytic Leukemia (CLL):
The most common chronic leukemia in middle aged adults; rarely occurs
in children.
Chronic Myelogenous Leukemia (CML):
This type of leukemia mainly afects adults. A person with CML may have
few or no symptoms for months or years before entering a phase in which
leukemia cells grow more rapidly.
Types of Leukemia (contd)
Rare type of leukemia:
Hairy cell leukemia:
A rare, slow growing cancer of the blood
Myelodysplastic syndrome:
A type of cancer in which the bone marrow doen no make
enough healthy blood cells and there are abnormal (blastic)
cells in the blood and/or bone marrow
Myeloproliferative disorders:
A group of conditions that cause blood cells (platelets,
WBCs, and RBCs) to grow abnormally in the bone marrow
Acute Lymphoblastic Leukemia (ALL)
Composed of immature precursor B-
(pre B) or T-lymphocytes (pre T)
85% of ALL are precursor B cell,
precursor T cell ALL are infrequent
Common malignancy under 15years;
peak age 2-5 years
Risk Factors: Trisomy 21, Ataxia-
Telangectasia, Bloom Syndrome
Lab investigation:
Anemia, neutropenia and
thrombocytopenia
Total WBC count elevated
Platelet count decreased
Hb: decreased
Peripheral smear: circulating leukemic
blast cells
Chronic Lymphocytic Leukemia (CLL)
Increased Peripheral blood
lymphocytosis
Most common type of
leukemia in Western world
Risk progressively increases
with age (>60 years)
More common in Males
Lab Investigation:
Anemia: Very late in disease
Total WBC count: Markedly
Elevated (100,000/mm
3
)
Peripheral blood smear:
Lymphocytosis, Smudge
cells (arrows)
Acute Myelogenous Leukemia (AML)
Proliferation of blast cells,
mainly in the marrow
Incidence: Adults (80%),
Children (15-20%)
Lab Investigations:
Total WBC count: Increase,
sometimes normal or
decreased
Anemia
Thrombocytopenia
Peripheral blood smear:
presence of atypical myeloid
cells, circulating blasts
Bone Marrow: >20% blasts
Auer Rods (arrows)
Chronic Myelogenous Leukemia (CML)
Incidence: Adults (25-60 years)
Presence of a distinctive molecular
abnormality
Philadelphia chromosome (9:22)
Inhibition of apoptosis and increase in cell
division
Lab Investigation:
Total WBC: >100,000/mm
3
Platelet count: Increased initially, later
thrombocytopenia
Peripheral blood smear:
Myeloid series in all stages of development
Eosinophils & basophils
Very low ALP activity (high in reactive leukocytes)
Bone Marrow:
Hypercellularity
Myeloid & megakaryocytic lineage
Eosinophils & basophils increase
Myeloblasts are <5%
Later stages show collage proliferation
Diagnostic tests
Medical history and physical examination
Complete blood count
Blood chemistry tests
Bleeding and clotting factors
Cytochemistry
Flow cytometry
Immunohistochemistry
Cytogenetics
Fluorescent in situ hybridization (FISH)
Polymerase chain reaction
Bone marrow aspiration and biopsy
Lumbar puncture
Lymph node biopsy
Hairy Cell Leukemia