Leukemia - Acute - Mature B cell ALL

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Leukemia - Acute

Mature B cell ALL

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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● Also called Burkitt leukemia, FAB L3
● See also Lymphoma and plasma cell neoplasms chapter
● WHO classifies Burkitt lymphoma with secondary marrow or peripheral blood involvement and ALL-L3 as same disease
● Variants are endemic, sporadic and immunodeficiency associated, which have different clinical and geographic presentations
● Extramedullary masses are prominent, often the presenting feature
● Pure leukemic involvement is rare
● Cases with mature B phenotype but no c-myc translocations are best classified and managed as pre-B ALL (Arch Pathol Lab Med 2003;127:1340)

Case reports
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● 53 year old woman with hepatosplenomegaly (Arch Pathol Lab Med 2004;128:1459)

Treatment
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● More intensive chemotherapy than standard ALL plus CNS prophylaxis; overall survival up to 50-70% in adults (Blood 2004;104:3009)

Micro description
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● Intermediate to large blasts with intensely basophilic cytoplasm containing prominent vacuoles, nuclei are round with coarse / mildly clumped chromatin and indistinct nucleoli
● Low power has starry sky appearance in biopsies

Micro images
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Peripheral blood (fig 1A), bone marrow Burkitt’s lymphoma
aspirate (fig 1B), bone marrow biopsy
(fig 2) and inset-CD20

Peripheral blood smears:

Large cells with prominent vacuoles

Bone marrow smears:

Large cells with basophilic cytoplasm and vacuoles

Stains:

Oil Red O+

Positive stains
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● CD10, CD19, CD20, CD22, CD79a, MUM1, PAX5, EBER
● Bright surface immunoglobulin with light chain restriction (overall is mature B cell phenotype)
● Oil Red O

Negative stains
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● CD5, CD23, CD34, TdT, BCL2

End of Leukemia - Acute > Mature B cell ALL

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