HEMATOPATHOLOGY CASES (1).pptx follicular mantle leukemia

Hematopathology cases

1. HEMATOPATHOLOGY CASES Dr. Yasmin M. AlSaidat

2. CASE (1) A 2-year-old male with no significant medical history presented with lower extremity pain and fever.

3. CBC

4. 88% Blasts Morphology: I ntermediate size, U niform features, S cant basophilic cytoplasm, S lightly condensed chromatin with inconspicuous / absent nucleoli.

5. E ffacement of architecture by round blue cells raises the differential diagnoses of ALL versus neuroblastoma, Ewing sarcoma and other mimickers. B and T cell precursors are morphologically indistinguishable .

6. Final diagnosis CD10-positive pre-B acute lymphoblastic leukemia (ALL).

7. Hematogones! Definition Hematogones are benign lymphoid precursors whose morphology and immunophenotype are similar to the blasts found in ALL. These cells are more commonly found in pediatric bone marrow aspirates following therapy. The clinical significance of expanded HGs is unknown, and the biologic features of these cells are still incomplete.

8. Morphologically hematogones are distinct lymphoid cells with  condensed and homogeneous chromatin, and scant cytoplasm. These cells can be observed in large numbers in the bone marrow of children with a variety of hematologic and nonhematologic disorders.  . The nucleus is round or oval and can exhibit one or more indentations or shallow clefts. Nucleoli were absent or small and indistinct. There is generally scant or no discernible cytoplasm; when present, cytoplasm is moderately to deeply basophilic and devoid of granules, inclusions, or vacuoles. There is often a variety of size and cytologic features that blends with those of mature lymphocytes.

9. Immunophenotyping Hematogones have a characteristic profile of CD38++, CD10+, CD19+, sIg -, CD20- or dim, and a cluster often found dimmer  and smaller on the CD45/log side scatter display.  The CD10, CD38, CD45 combination can be useful.  The goal is to distinguish ALL from normal precusor B cells.

10. CASE (2) 50 year old male patient, present with recurrent renal colic and back bone.

11. Examination General, cardiac, chest and abdominal examination were unremarkable except for flank tenderness.

12. Investigations CBC: Hb: 6, MCV: 95%, Plt : 224 Blood film : marked rouleaux formation. LDH: 231 Coomb’s test: negative. Bilirubin: total 0.5 KFT: urea: 38, create : 1, Na: 134, K:4.9 Calcium:12, Phosphoruus:4 , ALP: 92 LFT: AST: 10, ALT: 10

13. Investigations US: Bright liver, multiple right renal stones of variable size. CXRAY: Normal Upper GI endescopy and colonoscopy: Normal Skeletal survey: Multiple lytic lesions of skull and vertebra. Serum protein electrophersis and immnofixation : Monoclonal band, increase total kappa chain.

14. Rouleaux formation Red cells stack on each other (causing raised ESR)

15. Amyloid deposition Systemic AL amyloidosis is associated with nearly 15% of cases of multiple myeloma

16. Final diagnosis: Plasma cell myeloma, kappa light chain restricted. Estimated degree of involvement is 60%.

17. CASE (3)

18. Increased, monotonous appearing neoplastic follicles in an excisional biopsy of lymph node. The borders of the follicles are ill defined and lack well preserved mantle zones. Foci of sclerosis are identified

19. CD20 CD3 BCL2 CD10 BCL6

20. Case 4