Acute myeloid leukemia презентация

by:
Head of department of Pathological Anatomy
Sapargaliyeva Aigul

nonlymphocytic leukemia (ANLL),
is a cancer of the myeloid line of blood cells, characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells.

the leukemic cell (and the leukemia) may depend on the stage at which differentiation was halted.

minimally differentiated 5%
M1 acute myeloblastic leukemia, without maturation 15%
M2 acute myeloblastic leukemia, with granulocytic maturation t(8;21)(q22;q22), t(6;9) 25%
M3 promyelocytic, or acute promyelocytic leukemia (APL) t(15;17) 10%

more than 90% myeloblasts in blood and/or bone marrow and lack of any recurring chromosomal abnormalities such as t(8;21), t(15;17), inv(16) or t(16;16)(p13;q22). The distinction between AML-M1 and AML-M2 not otherwise specified can be arbitrary than real since it merely depends on the blast count. AML-M1 is also known as AML without maturation. Most blasts are large and typical of myeloblasts with prominent nucleoli.

is fine nuclear chromatin and scant to moderate amount of cytoplasm. Note that myeloblasts may not show any cytoplasmic granules or Auer rods as in this case. The correct identification rests upon immunophenotyping which shows expression of myelomonocytic antigens such as CD13, CD15, CD33, CD117, and myeloperoxidase. The blasts generally also express CD34 and HLA-DR.

myeloblast containing several fine rods-like structures called Auer rods. Auer rods are only seen in acute leukemias of myeloid differentiation.

case illustrates hypergranular morphology with most cells containing abundant large granules (arrows). Note the lack of more mature myeloid elements, such as metamyelocytes, bands, and segmented neutrophils. Also note the lack of erythroid elements. Although most cases show Auer rods, this particular case did not contain any Auer rods. The lack of Auer rods is a rare but well documented finding. This case had t(15;17) in all 20 metaphase cells and was also positive for PML-RAR fusion transcript by FISH study.

not only intact cells with abundant granulation are identified (arrow) but many ruptured cells are also seen releasing their granules free onto the slide (four arrowheads). The leukemic cells appear to be more fragile than normal promyelocytes and break apart upon smearing on the slides. In the absence of Auer rods, presence of abundant free large granules helps in differentiating leukemic promyelocytes from normal promyelocytes.

that is, polarity of cytoplasmic granulation. In many cells the granules tend to polarize toward one portion of the cytoplasm and the nucleus on the opposite side (arrows). In normal promyelocytes the granules are distributed rather evenly throughout the cytoplasm and polarization is not a distinct and obvious feature. When cytoplasmic granulation is heavy and polarized it is a good telltale morphologic sign of acute promyelocytic leukemia in the appropriate clinical context.

convoluted nuclear lobes (arrows). This feature is more common with hypogranular/microgranular form than hypergranular type but a few cells can usually be found in the hypergranular type as well. Normal promyelocytes DO NOT have dumbbell shaped or convoluted nuclear lobes.

cells can have a hypogranular/microgranular or typical blast morphology with fewer and finer granules and fine chromatin (curved arrows). When most cells show typical blast morphology, distinction from other acute myelogenous leukemia is difficult and the final diagnosis rests upon demonstration of the typical t(15;17) or positive FISH result for PML-RAR

marrow eosinophilia inv(16), t(16;16) 5%
M5 acute monoblastic leukemia (M5a) or acute monocytic leukemia (M5b) del (11q), t(9;11), t(11;19) 10%
M6 acute erythroid leukemias, including erythroleukemia (M6a) and very rare pure erythroid leukemia (M6b) 5%
M7 acute megakaryoblastic leukemia t(1;22) 5%

the non-erythroid cells are monoblasts.
Monoblasts (like their mature counterpart, monocytes) have convoluted nuclei (A).

typical of monoblasts at right.

blast cells in the bone marrow and blood precursors are represented essentially by monocytes.

to late polychromatophilic erythroid precursors (arrows).

Types

megacaryoblasts?

with more than 50% demonstrating megakaryocytic derivation by morphology

20%

50%

basophilic cytoplasm

with Down Syndrome

leukemia developed and its degree of maturity.
This is done by examining the appearance of the malignant cells with light microscopy and/or by using cytogenetics to characterize any underlying chromosomal abnormalities.

Conclusion