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Questions and Answers
Which of the following immunophenotypic features is characteristic of Early (pro/pre-pre) B-ALL?
What is the characteristic nuclear feature of L3 classification of ALL?
Which of the following is the most reliable diagnostic method for ALL?
What is the characteristic feature of L1 classification of ALL?
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Which of the following is NOT a characteristic of Pre-B-ALL?
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What is the characteristic feature of L2 classification of ALL?
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What is the most common type of leukemia in the Western hemisphere?
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What is the characteristic of lymphocytes in Chronic Lymphocytic Leukemia?
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What is the prognosis of Prolymphocytic Leukemia?
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What is the characteristic of T-cell Chronic Lymphocytic Leukemia?
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What is the laboratory finding in Chronic Lymphocytic Leukemia?
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What is the clinical manifestation of Prolymphocytic Leukemia?
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What is the characteristic of the chromatin in hairy cells?
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What is the term used to describe the accumulation of malignant cells and fibrous tissues in the bone marrow?
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What is the preferred type of specimen for enzymatic cytochemistry?
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What is the characteristic of the cytoplasm of prolymphocyte?
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What is the term used to describe the study of chemical elements found in cells?
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What is the characteristic of the nucleus of prolymphocyte?
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What is the characteristic of nucleoli in the cytoplasm?
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What is the function of the surface immunoglobulin in immunologic markers?
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What is the percentage of childhood cases that are classified as Common ALL?
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What is the characteristic of Pre-T-ALL cells?
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What is the name of the antibody used to identify ALL cells?
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What is the term used to describe Chronic Lymphoblastic Leukemia?
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What is the primary characteristic that distinguishes Acute Lymphocytic Leukemia from Chronic Lymphocytic Leukemia?
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Which of the following is NOT a common complication of Acute Lymphocytic Leukemia?
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What is the most common genetic mutation associated with T-ALL?
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Which of the following is a differential diagnosis for Acute Lymphocytic Leukemia?
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What is the primary reason for the development of serious infections in Acute Lymphocytic Leukemia?
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What is the typical age range for the onset of Acute Lymphocytic Leukemia?
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Study Notes
Diagnosis of Acute Lymphoblastic Leukemia (ALL)
- Romanowsky stained specimen (e.g., Wright stain) is used for diagnosis
- Cytochemistry, immunologic markers, and immunophenotyping are also used for diagnosis
- Genetic analysis is the most reliable method for diagnosis
Immunophenotypic Characteristics of ALL
- Early (pro/pre-pre) B-ALL: CD34, CD19, cytoplasmic CD22, TdT
- Intermediate (common) B-ALL: CD34, CD19, CD10, cytoplasmic CD22, TdT
- Pre-B-ALL: CD34, CD19, cytoplasmic CD22, cytoplasmic μ, TdT
FAB Classification of ALL
- Classified into L1, L2, and L3 based on:
- Occurrence of individual cytologic features
- Degree of heterogeneity
- L1: small cell, homogenous, regular nuclear shape, visible nucleoli
- L2: large cell, heterogenous, coarse chromatin, nuclear clefting, and folding
- L3: large cell, homogenous, oval to round nucleus, dense chromatin
Laboratory Findings of ALL
- WBC count: 25 × 10^9/L
- Prolymphocyte: relatively larger mononuclear lymphoid cell, oval to round nucleus, coarse-appearing chromatin strands, agranular cytoplasm
Hairy Cell Leukemia (HCL)
- Rare neoplasm, also known as "Leukemic Reticuloendotheliosis"
- Characterized by:
- Large spleen
- Presence of mononuclear cells with numerous cytoplasmic projections ("hairy cells")
- Laboratory findings:
- Presence of hairy cells
- Scant to abundant agranular cytoplasm
- Chromatin is loose/lacy
- B-cell markers: positive
- TRAP: positive
- CD123 and ANNEXIN A1: positive
- Pancytopenia: ↓ all
Cytochemistry
- Study of chemical elements found in cells
- Enzymatic and non-enzymatic elements
- Acceptable specimens: smears and imprints made from bone marrow, lymph nodes, spleen, or peripheral blood
Chronic Lymphocytic Leukemia (CLL)
- Most common type of leukemia in the Western hemisphere
- T-cell CLL: caused by HTLV
- B-cell CLL: chromosomal abnormalities, gain of extra chromosome 12
- Pathophysiology: proliferation and accumulation of lymphocytes that are relatively unresponsive to antigenic stimuli
- Clinical presentation: primarily affects elderly, manifestations include anemia, lymph nodes obstruction, splenomegaly, fatigue, bruising, pallor, jaundice, fever, and weight loss
- Laboratory findings: persistent lymphocytosis in the peripheral blood
Prolymphocytic Leukemia (PLL)
- Pathophysiology: proliferation and accumulation of abnormal lymphoid cells in the spleen, bone marrow, and liver
- Clinical manifestation: weakness, weight loss, sweats, fever, and enormous enlargement of the spleen
- Laboratory findings: nucleoli are visible, cytoplasm is basophilic and moderately abundant, and may contain vacuoles that may be stained with Oil Red O
Immunologic Markers
- Make use of surface immunoglobulins to identify B-cells and sheep erythrocytes to identify T-cells
- Uses monoclonal antibodies to identify cells
- Classes of ALL:
- Null/ Classified ALL: 10% of childhood, 40% in adults
- Common ALL: 75% in childhood, 40% in adults
- T-ALL: 15% in childhood and in adults, half of the patients have thymic masses
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Description
This quiz covers the second term of hematology, focusing on acute and chronic lymphocytic leukemia. It discusses the clinical manifestations, onset, and characteristics of the disease. Test your knowledge of this important topic in medical science.
