< #DeekshaSikri #Pathology In bits and pieces let's discuss leukemias and their characteristic features. First let's start with ALL- acute lymphoblastic leukemia/lymphoma (remember it can be either leukemia or lymphoma) They are of two types B and T. Arising from Pre B and Pre T cell respectively. The tumor cells are called Lymphoblasts. B- ALL are more common around the age of 3 (B-ALL, ball...so remember that way) as the number of Pre B cells in the marrow is at a peak at that time. They present as leukemias more than lymphomas.< #DeekshaSikri #Pathology OL Fre BD CeIS IM UWE IMamrhOW IS dla peak at that time. They present as leukemias more than lymphomas. T-ALL are more common in adolescents (T-ALL, tall...hence in older taller children) as the thymus reaches its maximum size at that time. They tend to present more as lymphomas than leukemias. A classic presentation would be a mediastinal mass (as per a previous exam question) oo®8 Deeksha Sikri Jun 14 at 14:07 #DeekshaSikri #Pathology #Basics HT mart anatincet ©0* Sahil Dhamija and 429 others > Suyash Vishwaroop Like + 2 + Share 4 Shelly Rana Jagraata start ¢) ©... Mayank Arya Sabki* 4 Shelly Rana Toh mene kab kaha... | f Deeksha Sikri | swear I havent even posted anything of consequence yet @ you guys are crazy Edited - Like - 28 + Share View 2 previous replies Mohammad Noor Alam replied 2 Aniket Mondal we're just BALL t... Mayank Arya #JagrataRocks w... Abhijit Sinha Poulami Paul iba 2. Obhaen Deeksha Sikrith ©0O% Sahil Dhamija and 429 others => eer Gree A Now. When something goes wrong with the genes of B cell and T cell developlemnt, ALL occurs. So these cells tend to get stuck at one stage and express markers of that stage. In B cell development, genes like PAX 5, RUNX1, ETV6 etc are involved. Hence you will see mutations in these genes in ALL. In T cell development, NOTCH1 plays an important role and to no surprise that is the one which is affected in majority of T cell ALL. And both PAX5 and NOTCH are exam questions @ bolo jai PGI and AIIMS and JIPMER Like » 53 + Share Deeksha Sikri = 4et ©0* Sahil Dhamija and 429 others > ted Sukhmin Singh nab better ma‘a... f, Khushboo Mehta Shaurin Pancholi Like + 1 + Share il ' i Deeksha Sikri Schematic diagram of a lymphoblast. Remember very scant cytoplasm, almost like a rim, no granules, and not very prominent nucleoli. IMMATURE[BSCELL (BSLYMPHOBUAST) High N:C Scant cytoplasm without granules Nucleus with variable, immature chromatin Less prominent nucleoli Deeksha Sikri turned off commenting for this post. 4et ©0O% Sahil Dhamija and 429 others => a Deeksha Sikri Schematic diagram of a lymphoblast. Remember very scant cytoplasm, almost like a rim, no granules, and not very prominent nucleoli. Like - 21 + Share a Deeksha Sikri Now look at these! What do you think these are?7Il Deeksha SikriEt ©0* Sahil Dhamija and 429 others > Load previous comments a Deeksha Sikri Now look at these! What do you think these are?7?!! Jun 1 at 22:40 + Like + i 10 + Share View 2 previous replies ie Akshita Agarwal Large cells - ly... Aastha Mashkaria Mam, agara... |@) Deeksha Sikri LymphoBLASTS Manish Pandey DrSanjay Agrahari Deeksha Sikri turned off commenting for this post.©0* Sahil Dhamija and 429 others > Karan Singla “Aa Rabia Arora Like + Share ] ' j Deeksha Sikri This virtual class shall not proceed without interaction from you guys. So tell me what markers will be positive in ALL? Like - 2 + Share (dy Akshita Agarwal CALLa (Cd10).. ted Sukhmin Singh Ma'am in very i... Deeksha Sikri Correct. Ig produ... Deeksha Sikri Very bland jagrata today. Sigh. No fun. Alvida karte hain kya ? Like - 4 + Share View 11 previous replies Deeksha Sikri Perfect. Deeksha Sikri = 4©0* Sahil Dhamija and 429 others > a { Deeksha Sikri Here are the important prognostic markers you should know about ALL Most importantly- Hyperdiploidy (more than 50 chromosomes), t(12;21) (more on this in a while), then age (2-7 years, more or less), female gender, and trisomies of 4, 10, 17 (sometimes even 7) are all good prognosis. Table 80.2 Prognostic Factors in Acute Lymphoblastic Leukemia Determinants Favorable Unfavorable White blood cell counts <10* 109/L >200 x 109/L Age 3-Ty 10y Gender Female Male Ethnicity White Black Node, liver, spleen enlargement Absent Massive Testicular enlargement Absent Present Central nervous system leukemiaAbsent Overt (blasts + pleocytosi: FAB morphologic features u l2 Ploidy Hyperdiploidy Hypodiploidy <45 Cytogenetic markers —Trisomies 4, 10, and/or 171(9;22) (BCR-ABL) 1(12;21) (TEL-AMLT) ——_(4;11) (MLL-AF4) Time to remission <14d >28d Minimal residual disease <104 >103 Patient Features Age (”) <30 Table 78.5 Prognostic Factors for Remission Duration a Acute Lymphoblastic Leukernia (1 Prognostic F Favorable 30 Unfavorable White blood cell count x(108/mi) Favorable 30,000 (>100,000 for T cell) Unfavorable immunophenotype Tcell ALL Favorable Mature B-cell ALL; early T-cell ALL Unfavorable Gytogenetics ip abnormality; (10;14)(q24;q11) ‘Favorable Normal; hyperdiploid Intermediate (9,22), t(4:11),t(1:19), hypodiploid, ~7, +8Unfavorable Response to therapy Complete remission within 4 wk Favorable Persistent minimal residual disease Unfavorable Deeksha Sikri turned off commenting for this post.©0% Sahil Dhamija and 429 others Te SelT Most common form of childhood ALL (*) Female preponderance WBC count is relatively low FAB L1 morphology mostly (*) PAS block positivity is seen (important point) Prognosis is usually good Methotrexate sensitivity present CD 10 + (CALLA - common ALL antigen) CD 34 + (primitive marker) TdT + (specific for lymphoblasts) So with these we know they are lymphoblasts With CD 19, PAX 5 positive we know they are B cell origin With MPO negative, we know its not myeloid Like - 28 + Share exes Debdip Saha Deeksha Sikrith ©0O% Sahil Dhamija and 429 others => a Deeksha Sikri | Let us see B ALL with high hyperploidy. 50-66 chromosomes (high) (47-50 is considered low hyperploidy) It is postulated that a leukemic clone arises in the intra uterine life itself Most common form of childhood ALL (*) Female preponderance WEC count is relatively low FAB L1 morphology mostly (*) PAS block positivity is seen (important point) Prognosis is usually good Methotrexate sensitivity present CD 10 + (CALLA - common ALL antigen) CD 34 + (primitive marker) Deeksha Sikri = 4Et ©0* Sahil Dhamija and 429 others > lymphoblasts With CD 19, PAX 5 positive we know they are B cell origin With MPO negative, we know its not myeloid Jun 2 at 00:43 + Like + i 28 + Share ~«, Debdip Saha Thanks a lot mam Jun 2 at 00:43 + Like * wm 1 * Share Deeksha Sikri B cell- Acute Lymphoblastic Leukemia with Hypereosinophilia- an interesting entity! Jun 5at19:17 + Like * i 14 * Share = Paras Bajaj Nivedita Chawla Deeksha Sikri turned off commenting for this post.et ©0* Sahil Dhamija and 429 others > ‘= Paras Bajaj a Nivedita Chawla Like = 1 + Share Bavin IB wa: Amal Sasidharan Like + Share | Shashi Yadav 4 Aniket Jaiswal Like + Share a Deeksha Sikri rp ere ey te Conreas Cine) CUR Suelo (AML1- ETO} rT (8:21) Cee => = FUSION irtares) Peel | erase Like - 11 + Share a Deeksha Sikri Deeksha Sikri©0* Sahil Dhamija and 429 others > Deeksha Sikri Important stains used in hematology for leukemia diagnosis. Cytochemical stain Specificity Myeloperoxisase (MPO) Sudan black 8 (588) Hineage, eosinophil granules granules of imes show Hci st f st acute yeloid leukaemia asociated with t(15;17) and %@:21) Stains monocytes and macrophages, megakaryocytes and platelets, most Tymphocytes td some Thmphoblasts ora) wsmonoeytes and macrophages; var f Tlymphocytes Pr phi ‘ytoplasm (blocks), monocytes (difuse plus gran ules), megakaryocytes and platelets (Gitfuse plus granules), some T and 8 lymphocytes, and many leukaericblast cells (blocks, B s t Tlymphooytes, T lymphoblasts a vegakaryoblasts s s phages and, occasionally, plasma cells The silable Like - 11 + Share j Deeksha Sikri And please focus on the last line- these stains are redundant if immunophenotyping that means flow cytometry is available Like - 12 + Share Deeksha Sikri= ©0* Sahil Dhamija and 429 others leukemogenic mutations and the mutations leading to arrest of cells come under Class II leukemogenic mutations. Following is the cell that is my second favorite to see in hemat- a myeloblast. Look at it. Big. High N:C ratio but not as bad and high as in lymphoblasts above. There maybe some granules in the cytoplasm and those might join to form an Auer rod which when seen tells me without a shred of doubt that this is a myeloblast. MY EVOBUASTIWITHTAUERTROD] — Prominent One or more ‘Auer rods. Scant light blu with immature cytoplasm toym chromatin 10; Like 18° Deeksha Sikri turned off commenting for this post.et ©0O% Sahil Dhamija and 429 others => Be. Now, for AML we know that to diagnose i need 20% blasts or more in the marrow (PLEASE NOTE IN THE MARROW) AML means acute myeloid leukemia- primary issue is arrest of myeloid cell at the stage of myeloblast or any other immature precursor and then undergoing clonal proliferation. The mutations leading to clonal proliferation are called Class | leukemogenic mutations and the mutations leading to arrest of cells come under Class II leukemogenic mutations. Following is the cell that is my second favorite to see in hemat- a myeloblast. Look at it. Big. High N:C ratio but not as bad and high as in lymphoblasts above. There Deeksha Sikri = 4et ©0O% Sahil Dhamija and 429 others => LIKE * Olidle 222 Abhijit Sinha Poulami Paul follow this Like + Share a Deeksha Sikri . Take a moment here and compare the two pictures- look for the prominent nucleolus inside the nucleus. A punched out area- stains lighter than the rest of the nucleus. PN) eee Cmts Celt holes in the nucleus of the POC Rice NCE CVE eC) eiod rods in the cytoplasm! Like - 19 + Share al Aheed Khan Thank you so much... MM) naabcha Cileri | caam ta hava im Deeksha Sikriet ©0% Sahil Dhamija and 429 others > Lal Aheed Khan Thank you so much... a Deeksha Sikri | seem to have im... faye, Gaurav Bhavsar 123 ha Thank you ma'am Like + Share a Deeksha Sikri Acute promyelocytic leukaemia BiBepnuctens _ OC r ‘Dwer Revs ceaaent: porte aa Cranulated i} g opt eptete eases Amar Boas pies feta g aS (Amt-m3) FaGhb ; am ° oe rainy eal Like + 21 + Share Abhijit Sinha Poulami Paul Like + Share Deeksha Sikri turned off commenting for this post.