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Leukemia - Acute

General


Reviewer: Syed Zaidi, M.D. (see Reviewers page)
Revised: 23 December 2011, last major update December 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Definition
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● “Acute” because cells are immature (usually blasts) compared to mature hematopoietic cells in chronic leukemias
● Acute leukemias also tend to progress rapidly without treatment, compared to indolent behavior of chronic leukemias

Clinical features
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● Ionizing radiation is only definite environmental risk factor (Environ Health Perspect 2007;115:138)
● Course of disease not affected by pregnancy (Cancer 2005;104:110)
● Initial diagnosis usually based on blood counts and blood smear
● Bone marrow examination (biopsy and smears) is necessary to confirm diagnosis and to obtain material for special studies
● Bone marrow biopsy is essential to assess cellularity extent of involvement and to monitor post-treatment changes
● Cytogenetics and molecular studies are required to classify and provide prognostic information
● Before making a diagnosis, review clinical information, all pathology material and special studies
● Immunostains should be ordered in panels (with multiple antigens) since aberrant antigen expression is common
Common lymphoid immunostains: TdT, T cell - CD2, CD3 (cytoplasmic), CD5, CD7; B cell - HLA-DR, CD10, CD19, CD22, CD79a (cytoplasmic), PAX5, CD20 (tissue sections)
Common myeloid immunostains: CD13, CD14, CD15, CD33, CD36, CD61, CD64

Post-treatment:
● Initially hypocellular with necrosis, proteinaceous debris, dilated sinuses and increased reticulin
● Regeneration begins after 1-2 weeks
● May be difficult to differentiate residual disease (tumor cells in no specific locations) from regenerating marrow (promyelocytes are perivascular and endosteal), particularly in acute promyelocytic leukemia
● May have granulomas associated with microorganisms

Micro description
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● Bone marrow usually markedly hypercellular with replacement of normal cells by myeloblasts
● Myelofibrosis relatively common
● Marrow is rarely hypocellular resembling aplastic anemia, but most cells are blasts

End of Leukemia - Acute > General


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