بسم الله الرحمن الرحيم Acute lymphoid leukemia(ALL) Prepared by :: هبة ابونومر..هند أبوعريبان..نسايم حسونة Supervisor:: ابتسام الاسود

Case study 9 years old children come to hospital for a history of fatigue , pallor, Shortness of breath , recurrent infection and bleeding.your order some test and find bone marrow>20% blast cell

Laboratory finding CBC Normal range The result 3.9-5.3 2.28*106 RBC 4.5-12.5 μl/40 *103 WBC 150-450 μl/50 *103 PLT 11.5-15.5 dl/8mg HB

Morphology under microscope Describe this photo?

Morphology under microscope lymphoblast is a small blast with scant cytoplasm, dense chromatin, indistinct nucleoli, and no auer rods &granule.

Cytochemistry Negative for myeloperoxidase &non specific esterase

Immunological marker(immunophenotyping) Positive for TDT (terminal deoyxtidyl transferase) , CD7+ &CD3+.

Diagnosis What is the best diagnosis for these case and why? -It is acute lymphoid leukemia -It have many blast cell this mean it is acute not chronic. -myeloperoxidase& non specific esterase negative this mean lymphoid not myloid. -TDT+,CD7+ &CD3+ this mean in T-cell not B-cell.

What is acute lymphocytic leukemia? Acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, is a cancer that starts from the early version of white blood cells called lymphocytes in the bone marrow (the soft inner part of the bones, where new blood cells are made). Leukemia cells usually invade the blood fairly quickly. They can then spread to other parts of the body, including the lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testicles (in males). Other types of cancer also can start in these organs and then spread to the bone marrow, but these cancers are not leukemia. The term “acute” means that the leukemia can progress quickly, and if not treated, would probably be fatal within a few months. Lymphocytic means it develops from early (immature) forms of lymphocytes, a type of white blood cell. This is different from acute myeloid leukemia (AML), which develops in other blood cell types found in the bone marrow.

accumulation of blasts in the marrow

Two-hit model of leukemogenesis Loss of function of transcription factors needed for differentiation eg. AML1-ETO CBFb-SMMHC PML-RARa Gain of function mutations of tyrosine kinases eg. FLT3, c-KIT mutations N- and K-RAS mutations BCR-ABL TEL-PDGFbR differentiation block enhanced proliferation Acute Leukemia +

Classification of leukemia Main classification Chronic leukemia Acute leukemia FAB Lymphoid Myeloid Myeloid Lymphoid L1 L2 L3 AML M0 M1 M2 M3 M4 M5 M6 M7

What the type of ALL!

What the type of ALL in these pictures??

Type of ALL is L1

FAB Characterization for ALL L1: Homogenous population of small lymphoblasts with scanty cytoplasm and scanty nucleoli. Nucleus occasionally cleft. L2: Heterogeneous population of large lymphoblasts with moderately abundant cytoplasm & or more nucleoli. Nucleus commonly intended or cleft. L3: Burkitt’s type: Homogenous population of large lymphoblasts with prominent nucleoli & deeply basophilic, vacuolated cytoplasm.