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TRAP- hairy cell
Myeloperoxidase-
myeloblastic and monocytic AML
Quick Guide to Cytochemistry
L1 and L2 stain positive for PAS- "block staining"
cyanide-resistant peroxidase-
eosinophils
PAS- M6 only in AML
SBB pos- except M0
will be neg for:
-peroxidase
-myeloperoxidase
-cyanide-resisitant peroxidase
-Sudan Black
Will be positive for:
-TdT
NSE pos:
-monocytes, megakaryocytes
SE pos:
- all myelocytic
Peroxidase-
primary myloid, platelets, and eos
NSE pos in some T lymphs
combined esterase evalulate monocytic to myelocytic lines
AML
ALL
Stains:
Peroxidase and sudan black (=)- lymphoid lineage
TdT (+)
Good Prognosis
15-25% of all ALL
present with: medialstinal mass, very high WBC count, and hepatosplenomegaly
males more than females
CD markers:
CD5: bad prognosis
CD3: worse prognosis
t(1;14)
T Cell Acute Leukemia
Anemia: N/N with thrombocytopenia and PREDOMINANCE OF BLASTS
FAB: L1
Must know markers:
- t (12;21) TEL-AMLI and expression of CD 10 and CD19 (not 20)
(memory tip: TEL-AMLI is inverse 12,21 CD markers: 10 + 19 does not equal 20)
B Cell Acute Leukemias
(memory tip: if you do that classic Catholic cross gesutre you make a T- Tcell- right at your mediastinum)
Stains:
TdT (+)
Hint: although an ALL, this is observed with mature B-lymphs and will therefore be in the mature lymph section
ALL
Early Pre-B Cell Lymphoblastic Leukemia
Lymphoblast
Myeloblast
Memory tool:
ALL kids get ALL
- ALL is found in children 75% of the time
Look at those Auer Rods!
Rare
Proliferation in BM: >50% blasts are megakaryocytic in origin
PAS usually pos
MPO, SBB neg
>30% WBC are myeloblast
>50% of nucleated bone marrow cells are erythroid precursors
Proliferation in marrow of megaloblstoid erythroblasts
N/N anemia
with weird nucleated RBC
PAS stain pos
Both megakaryocyteand erythrocytes originate from a myeloid precursor and are therefore classified as AML
M1-
minimal differentiation
15% of adult cases of AML
Sudan black (+), peroxidase (+), 20% NSE (+)
M0-
no definitive differentiation
CD33, CD13, CD117
NSE (=), myelo peroxidase (=), Sudan black (=)
M2-
some maturation *>10% immature cells are promylocyte or older
25% of adult cases- most common
favorable prognosis:
CD 13, 33, 117 (rule of 3s and 7s) and 19, 34, 56
Translocation of t(8;21)
Acute Myeloid Leukemia
M6:
Erythroleukemia or DiGuglielmos
Auer Rods begin!
M7:
Megakaryoblastic Leukemia
Poor prognosis
Memory hints:
M0= 0 defining characteristics
CD markers- rules of 3s and 7s
Promyelocyte
>30 % non-erythroid cells are pros (often have auer rods)
often presents with signs and symptoms of DIC (and thrombocytopenia included)
10% of all adult
Markers: Has rule of 3s and 7s but lacks HLA-DR and 34
M3
check D-dimer
Memory hint: DIC is a deadgivaway for M3
Myelocyte
Myelocytic and monocytic differentiation
CD Markers: rule of 3s and 7s, 11, 14, 64, 4
Muramidase is increased
M4Eo- immature eos in bone marrow
>80% of WBC are from monocytic line
--auer rods still possible
anemia and thrombocytopenia
Peroxidase (=), Sudan black (=), NSE (majority +),
Most often die before treatment
Memory hint: rules of 3s and 7 changes to 3s, 7s, and 4s for M4
Helpful hint: SE compared to NSE will confirm
M4:
Acute Myelomonocytic
M5:
Acute Monocytic