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Leukemia - Acute

AML not otherwise categorized

Acute basophilic leukemia

Reviewer: Daniela Mihova, M.D. (see Reviewers page)
Revised: 1 February 2013, last major update September 2012
Copyright: (c) 2001-2013, PathologyOutlines.com, Inc.

General
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● Rare (< 1% of AML); tumor cells have basophilic differentiation
● Associated with marrow failure, circulating blasts, skin involvement, organomegaly, hyperhistaminemia symptoms and lytic lesions
● Diagnosis: may require EM (Am J Clin Pathol 1991;96:160)
● Enzyme cytochemistry: myeloperoxidase+ by EM but negative by light microscopy; acid phosphatase+; variable PAS+ in blocks and lakes; Sudan Black B-, non-specific esterase-
● Poor prognosis

Case reports
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● 18 year old man with 11q23 gene rearrangement (Indian J Pathol Microbiol 2007;50:443)
● 72 year old man with monosomy 7 as only abnormality (Cancer Genet Cytogenet 2007;172:168)
● Anaphylactoid reaction after chemotherapy and disseminated intravascular coagulation with massive pulmonary hemorrhage (Cancer 1995;75:110)

Treatment
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● Imatinib if bcr-abl present (Ann Biol Clin (Paris) 2006;64:361)

Micro description
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● Hypercellular marrow composed of medium sized blasts with high N/C ratio, moderate basophilic cytoplasm with variable number of coarse basophilic granules and cytoplasmic vacuoles
● Nucleus is round, oval or bilobed with 1-3 prominent nucleoli
● Occasional immature basophils; dysplastic erythroid features

Micro images
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Basophilic leukemia

Peripheral blood:

Immature basophilic precursors

Bone marrow smears:

Most blasts lack differentiation, but one blast has coarse azurophilic granules

Bone marrow biopsy:

Blasts and immature basophils with variable nuclear size and nucleoli; also plasma cells, endothelial cells and hemosiderophages

Stains:

Maturing basophils have metachromatic granules with toluidine blue stain

Positive stains
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● CD11b, CD13, CD33, CD34, CD123, CD203c (Eur J Clin Invest 2001;31:894)
● Toluidine blue (metachromatic granules), HLA-DR; variable CD9, membranous CD22 and TdT

Negative stains
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● Myeloperoxidase by light microscopy
● CD117-, tryptase- and CD25- distinguish from mast cell leukemia

Molecular description
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● No specific findings; cases with t(6;9)(p23;q34) and with BCR-ABL1 are excluded

Electron microscopy description
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● Coexistance of basophilic granules and immature mast cell granules

Electron microscopy images
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Granules contain amorphous speckled substance, one granule has a myelin figure

Differential diagnosis
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● AML-M0 - EM shows no basophilic granules
● AML-M2 subtypes with basophilia: see Am J Hematol 2004;76:134
● Acute eosinophilic leukemia
● ALL with coarse granules
● CML in blast crisis
● Mast cell leukemia

End of Leukemia - Acute > AML not otherwise categorized > Acute basophilic leukemia

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