acute lymphoblastic leukaemia associated with burkitts lymphoma.pptx

Just a medico helping fellow soldiers

1. ALL

2. Leukaemia is acute if more than 20%blasts are present in bone marrow.

3. Lymphoblast Myeloblast Small size Large size Scanty cytoplasm Moderate cytoplasm No granules in cytoplasm Granules + Aeur rods - + Faggot cells - + Chromatin - Chromatin - Incospicious nucleoli 2 to 5 prominent neucleoli Stain - MPO,SBB+,NSE+

4. Age of patient – 2 to 9 years. Most common cancer in children. Clinically presents with decreased hemoglobin, pallor and fatigue, decreased WBC, decreased platelets and bleeding tendency. Hepatosplenomegaly Bone pains/ sternal tenderness. CNS, testis, spleen, lymph node involvement can be seen.

5. FAB classification ALL-L1 – most common type of ALL. Best prognosis. Small homogenous blasts with scanty cytoplasm and incospicous nucleoli. ALL-L2 – large blasts, heterogenous blasts, moderate cytoplasm and prominent nucleoli. Difficult to differentiate from AML. ALL-L3 – least common type of ALL. Worst prognosis. Bluish cytoplasm, vacuoles in burkitts lymphoma

6. B-ALL T-ALL Most common Least common Children Adolescents Tissue invasion absent Tissue invasion present Mediastinal involvement is absent Mediastinal involvement is present Mutation in PAX-5, E2A, EBF transfer factors Gain of function mutation in NOTCH 1 gene. Better prognosis Poorer prognosis

7. Lab diagnosis of ALL A child with hepatosplenomegaly, pancytopenia CBC – hb , tlc , platelets are all decreased. Peripheral smear shows more than 20% lymphoblasts, scanty granules, cytoplasmic protrusions and look like hand mirror cells. Peripheral smear shows >20% lymphoblasts Aleukemic leukemia is seen when no blasts in peripheral blood is seen. Bone marrow aspirate shows more than 20% lymphoblasts. Stains used are PAS + Lymphoblasts shows dot or block positivity on PAS AML-M6 is PAS + and diffuse positivity

8. Treatment Stem cell transplantation Vincristine L-asparaginase Prednisolone Doxorubicin