Case 10 New Frontiers in Pathology, 2009 William G. Finn, M.D.

Slides:



Advertisements
Similar presentations
Acute Myeloid Leukemias Diagnosis in The Light of WHO Revisions And Correlation With Risk Adaptive Management ; Case Discussions Dr. Rania Medhat Seliem.
Advertisements

Acute Lymphoblastic Leukemia An Overview
1 Understanding the Blood Count in the Pediatric Oncology Patient Gina Brandl RN, BSN, MSN-Cand Pediatric Clinical Nursing Instructor Mid-State Technical.
CP Unknown Heme-10/19/2011 Kumaran Mudaliar and Girish Venkataraman
Minimal Residual Disease in Hematologic Neoplasms Lloyd M. Stoolman, M.D. Professor of Pathology and Director, Clinical and Research Flow Cytometry Laboratories.
Supportive Care in Multiple Myeloma
TA OGUNLESI (FWACP)1 CHILDHOOD LEUKAEMIA. TA OGUNLESI (FWACP)2 LEUKAEMIA Heterogenous group of malignant disorders Characterised by uncontrolled clonal.
A Hematology Case Study about Leukemia by Sarah Wycoff
Acute leukemia Mohammed Al-matrafi.
Myelodysplastic Syndrome
Hemostatic System - general information Normal hemostatic system –vessel wall –circulating blood platelets –blood coagulation and fibrynolysis Platelets.
ECSI case Fall 2014 Andrea M. Sheehan, MD Associate Professor of Pathology & Immunology Baylor College of Medicine.
Acute Leukaemia Dr. Soheir Adam, MRCPath Assistant Professor Department of Haematology, KAUH.
Identification and Diagnosis of the Acute Leukemias
PBL 6 Quiz.
Chapter 17 Chronic Leukemias.
Chronic Leukemia Dr. Rania Alhady Chronic Lymphocytic leukemia (CLL):
Chronic leukemias. Chronic myelogenous (granulocytic) leukemia Is characterized by an unregulated proliferation of myeloid elements in the bone marrow,
Chapter 25: Acute Lymphoblastic Leukemia. Causes a wide spectrum of syndromes – From involvement of bone marrow and peripheral blood(leukemias) to those.
Acute Myeloid Leukemias (AML)
NYU Medicine Grand Rounds Clinical Vignette Maryann Kwa, MD PGY-2 January 12, 2011 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Oncology Slide Review LaJuan Chambers, MD. 16 yo young man with fatigue, pallor and low-grade fever for 2 weeks On exam, spleen palpated 8cm below left.
NURSING CARE OF THE CHILD WITH A HEMATOLOGIC ALTERATION.
Case Study MICR Hematology Spring, 2011 Case # 6 Monique Quiroz Mike Pehl Andrew Ho.
Acute Myeloid Leukemias Diagnosis in The Light of WHO Revisions And Correlation With Risk Adaptive Management ; Case Discussions Dr. Rania Medhat Seliem.
Leukemia.
Leukemia By: Gabie Gomez. What is Leukemia? Blood consists of plasma and three types of cells, each type has a special function. RBC, WBC and Platelets.
4th Year Medical Student KAU
Hematology and Hematologic Malignancies
Chronic leukemia 1. Chronic Lymphocytic leukemia (CLL) * Definition: Chronic neoplastic disorder characterized by accumulation of small mature-looking.
Leukemia Omidreza keshavarz Ahmad darvishi Nursing 86 Hormozgan university of medical sciences Bandarabbas faculty of nursing،midwifery and paramedical.
Heterogeneous group of hematopoietic neoplasms Uncontrolled proliferation and decreased apoptotic activity with variable degrees of differentiation Composed.
Leukaemias. Leukaemias: Malignant Disease of WBC Forming tissue or other hemopoietic elements: Lymphoblastic (ALL) Lymphoblastic (ALL)Acute Myeloid (AML)
TCR gamma/delta LGL proliferation causing recurrent episodes of neutropenia proceeding into fatal hepatosplenic T-cell lymphoma in an adolescent girl 5.
MLAB 1415: Hematology Keri Brophy-Martinez
MLAB Hematology Keri Brophy-Martinez
MLAB Hematology Keri Brophy-Martinez
Acute Leukemia Kristine Krafts, M.D..
1 CASE REPORT hematology Monika Csóka MD, PhD year old boy no abnormalities in previous anamnesis 2 weeks before viral infection (fever, coughing)
LEUKEMIA Dr. Omar Alshaer. Acute Leukemia.
Acute lymphoblastic leukemia in children
AML Clinical Presentation. Clinical Presentation: Symptoms Fatigue (50%) Anorexia and weight loss Fever with or without an identifiable infection (10%)
CHAPTER 7 DISORDERS OF BLOOD CELLS & VESSELS. HEMATOPOIESIS Generation of blood cells Lymphoid progenitor cells = lymphocytes (WBCs) Myeloid progenitor.
Acute Leukemia Kristine Krafts, M.D..
Blood Biochemistry BCH 577
CASE OF THE MONTH Dr Narender Tejwani Consultant ( Hematopathologist)
Differential WBC Counting
White blood cells disorders
Pathophysiology of Febrile Neutropenia
ICCS e-Newsletter CSI Yao Schmidt, MD Department of Pathology
Chronic Leukaemias Heterogeneous group of hematopoietic neoplasms
Chronic Leukaemias Heterogeneous group of hematopoietic neoplasms
Figure 2 Percentage of CD19+/CD34+ cells with decreased CD81 median fluorescence intensity (MFI;
Early T-Cell Precursor ALL in 5 Year Old Female
Symptoms and Signs in Hematology/ 2013
Building better therapy for children with acute lymphoblastic leukemia
Leukemia Case 1.
Chronic Leukemia Kristine Krafts, M.D..
by Vishal Bhatnagar, and Ashkan Emadi
Case:2 leukemia دينا نعمان جرادة جيهان ايمن مقاط.
LEUKEMIA CASE STUDY 2.
Header Supplemental Questions to Malignant Peripheral Blood and Bone Marrow Review Mark D. Fleming, M.D., D.Phil. Subhead.
Diagnostic Hematology
Erythroid karyorrhexis in myelodysplasia: bone marrow aspirate
Erythroid leukemia evolving from multiple myeloma
A presentation By Abedelaziz Taha Hammash supervisor \ Mr
Case study.
A Case Report Ahmad Adel A..
CHRONIC LEUKEMIA BY: DR. FATMA AL-QAHTANI CONSULTANT HAEMATOLOGIST
Langerhance Cell Histiocytosis (LCH) 5 Years After B-cell Acute Lymphoblastic Leukemia in a 11 year-old boy Professor. Ansari Professor of pediatric hematology.
Presentation transcript:

Case 10 New Frontiers in Pathology, 2009 William G. Finn, M.D. University of Michigan

History A 3-month-old girl was referred to the pediatric hematology-oncology service for persistent neutropenia. She had been born premature at 32 weeks gestation, with time in NICU. At birth she had a white blood cell count of 9x109/L and an absolute neutrophil count of 1.5x109/L (both within reference range). Over the following 3 months her neutrophil count decreased to as low as 0.5x109/L. A bone marrow aspiration was performed.

Findings Acquired anemia/ neutropenia in an infant Numerous immature cells in marrow Leukemia?

Acute Leukemia in Children Signs and symptoms (variable among patients) Fatigue Pallor Petechiae Cytopenias Organomegaly Lymphadenopathy

Leukemia? Pros Persistent idiopathic cytopenias (neutropenia, anemia) Marked increase in immature cells in marrow (>20%) Cons Normal platelet count No leukocytosis (O.K. for A.L.L. but uncommon in infant A.L.L.) Clinically stable, not acutely ill

Our Patient A.L.L.

Flow Cytometry B-A.L.L. in children: CD19+, CD10+, CD20+/-, CD22+/-, CD34+/-, CD38+, TdT+

Flow Cytometry Our patient: CD19+, CD10+, CD20+/-, CD22+/-, CD34+/-, CD38+, TdT+

Flow Cytometry – A.L.L. CD33 CD45 CD34 CD19 Side Scatter CD10

Flow Cytometry – A.L.L. CD19 CD38 CD45 CD5 Side Scatter CD20

Flow Cytometry – Our Patient CD33 CD34 CD45 CD19 Side Scatter CD10

Flow Cytometry – Our Patient CD19 CD38 CD45 CD5 Side Scatter CD20

Flow Cytometry – Our Patient CD33 CD34 CD45 CD19 Side Scatter CD10

Flow Cytometry – Our Patient CD19 CD38 CD45 CD5 Side Scatter CD20

Flow Cytometry – Our Patient CD33 CD45 CD34 CD19 Side Scatter CD10

Flow Cytometry – Our Patient CD19 CD38 CD45 CD5 Side Scatter CD20

Hematogone Hyperplasia Diagnosis Hematogone Hyperplasia

Hematogones Physiologic B-cell precursors “Mystery Cells” Normal counterpart to B-precursor lymphoblasts Substantially resemble leukemic lymphoblasts, both morphologically and immunophenotypically

Hematogones Proliferate in a variety of reactive states, most notably in children Autoimmune cytopenias (ITP, etc) Recovery from chemotherapy (including A.L.L. therapy) Hematogone hyperplasia usually <10% of nucleated cells in marrow, but occasionally much higher, raising differential diagnosis with acute leukemia

Hematogones May be distinguished from leukemic lymphoblasts by a characteristic pattern of maturation, both morphologically and immunophenotypically

Hematogones Maturation pattern by flow cytometry very consistent and reproducible-- readily distinguishable from lymphoblasts Analysis should be iterative, based on known patterns at each stage of maturation Evaluate patterns not lists of markers Avoid simple “gate and analyze” approach Treat as data not as dot-plots

Hematogones-immunophenotype CD45 dim in early forms, brighter in later forms Low side angle light scatter

Hematogones-immunophenotype CD19 increases slightly with maturation CD10 bright in early forms, slightly dimmer in later forms, negative in mature B-cells

Hematogones-immunophenotype CD20 increases progressively with maturation CD34 uniformly positive in earliest forms, then negative (no gradual progression) CD38 uniformly positive in early and later forms, then variable in mature B-cells (no gradual progression)

Hematogones-immunophenotype TdT expression mirrors CD34 expression No expression of myeloid antigens

Our Patient A.L.L.

Summary Hematogones are physiologic B-cell precursors; normal counterpart to B-lineage lymphoblasts May become hyperplastic in numerous reactive conditions, especially in children Often seen in recovery from anti-leukemic therapy– diagnostic pitfall

Summary May be present in high enough percentage to mimic overt leukemia Readily distinguished from lymphoblasts by careful morphologic and immunophenotypic assessment