morphology review - ish slides - 제 2 차 혈액학 종합학술대회 발표 2000 년 5 월 25 일...
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Morphology Review- ISH Slides -
제 2 차 혈액학 종합학술대회 발표2000 년 5 월 25 일 -5 월 26 일
COEX
한림의대 조 현 찬
Clonal Bone Marrow Disorders
Metastatic Cancers
Lymphoma
FAB Classification Standard morphologic classification system Features considered
Morphology : Cell size, Amount of cytoplasmNuclear size and shape, Cytoplasmic membrane Cytoplasmic basophilia,
Cytoplasmic vacuolations, Other features Cytochemistry Immunophenotype cytogenetic & molecular genetic features Other features
M3
M5
M7
M6M1
M2
M0
M4
WHO Classification of Hematologic Malignancies
Myeloid Neoplasm Lymphoid Neoplasm Mast Cell Disorders Histiocytic Neoplasm
Diagnistic criteria Morphology Immunophenotype Genetic features Clinical syndromes
AMLs with recurrent cytogenetic translocations AML with t(8;21), AML1/ETO
Acute promyelocytic leukemia with t(15;17) AML with abnormal BM eosinophils with inv(16) AML with 11q23 (MLL) abnormalities AML with multilineage dysplasia AML & MDS, therapy-related AML not otherwise categorized AML minimally differentiated AML without maturation AML with maturation Acute myelomonocytic leukemia Acute monocytic leukemia Acute erythroid leukemia Acute megakaryocytic leukemia Acute basophilic leukemia Acute panmyelosis with myelofibrosis
AML, WHO Classification
(# 01) 69-year-old male Bone marrow film Poorly or minimally differentiated AML (AML-M0)
(#02) 5-year-old male, BM Acute myeloid leukemia (AML-M5a)
(#03) 67-year-old woman presented with pancytopeniaAcute megakaryoblastic leukemia
(#13) 9-year-old male with pancytopenia, BMMetastatic rhabdomyosarcoma
Morphology : The tumor cells vary in size; many have irregular cytoplasmic pseudopods. Occasional cells have cytoplasmic vacuoles.
Immunophenotype : CD41 (GpIIb/IIIa) (+) Tentative diagnosis : acute megakaryocytic
leukemia was established. Ultrastructural exam : Rhabdomyosarcoma
(#05) Newborn with Down syndromeTransient abnormal myelopoiesis(TAM) in Down syndrome
PB ; WBC 88 x 109/L, Hb 14.2 g/dl and platelets 12 x 109/l. Blast 50-60%
No phenotyping or chromosome studies. WBC count gradually returned to normal
over 10 weeks. There has been no recurrence and the child is well at nine years of age.
The blasts may express megakaryocytic and/or erythroid markers; promegakaryocytes and micromegakaryocytes may be numerous.
The CBC findings are not helpful in distinguishing the transient disorder from those processes which persist.
• Refractory anemia (RA) • RA with ring sideroblasts (RARS) • RA with excess of blasts (RAEB) • RAEB in transformation (RAEB/T) • CMML
Other Subtypes MDS with myelofibrosis Hypoplastic MDS Pure sideroblastic anemia
MDS, FAB Classification
MDS, WHO Classification Refractory anemia
with ringed sideroblastswithout ringed sideroblasts
Refractory cytopenia(MDS) with multilineage dysplasia
Refractory anemia with excess blasts 5q- syndrome MDS, unclassifiable
(#04) 37-year-old female house painter with a history of bruisingRAEB-T associated with an isolated 5q-
Congenital dyserythropoietic anemia, type III (#07) 27-year-old male, Hb 9.7 g/dl , BM
Chronic Myeloproliferative Disorders
Chronic myeloid leukemia
Atypical CMLJuvenile CMLChronic neutrophilic leukemia
Polycythemia vera Myeloid metaplasia with myelofibrosis Essential thrombocythemia
MPD, WHO Classification Chronic myelogenous leukemia, Ph(+) (t(9;22)
(q34;q11), BCR/ABL) Chronic neutrophilic leukemia Chronic eosinophilic leukemia/hypereosinophilic
syndrome Chronic idiopathic myelofibrosis Polycythemia vera Essential thrombocythemia Myeloproliferative disease, unclassifiable
Myelodysplastic/myeloproliferative disorders (MD/MPD) CMML, aCML, JMML
(#08) Ph(+) chronic myeloid leukemia
(#09) 45-year-old male PB film with Ph(+) CMLMixed lineage (B-lymphoid and myeloid) blast crisis of CML
Lymphoid neoplasm,WHO Classification
B-Cell neoplasm Precursor B-cell : ALL Mature(peripheral) B-cell : CLL, HCL, PCM, MCL , Burkitt’s Lymphoma
T-cell and NK-cell neoplasm Precursor T-cell Mature(peripheral) T-cell
Hodgkin’s lymphoma
(#10) 47-year-old male with an abdominal mass, PBRichter's transformation of B-cell CLL
(#11) 47-year-old male with easy bruisability and lethargy, BMPlasma cell leukemia
70/F, Sternal pain for 6 years (SNUH)CBC : 8.5 - 3.8 - 163kTotal protein/Albumin : 6.2/3.3, PEP : no M-spike
Plasma cell myeloma with heavy granules
Plasma cell leukemia, PB Multiple myeloma, BM
(#12) 66-year-old male, PB Mantle-cell lymphoma in leukemic phase
Morphology : medium size lymphoid population having a nucleus with dense but not clumped chromatin, occasional nuclear clefts and a small nucleolus.
Immunophenotype : clonal B-cell population with strong expression of SIg and membrane CD22(+), CD5(+), CD23(-)
Cytogenetic analysis : t(11:14)(q13;q32) Spleen histology : diffuse involvement by
medium size lymphocytes with a cleaved nucleus
Hairy cell leukemia
Middle-aged patients over 50 Weakness and lethargy Splenomegaly (80% )
Hairy cells : Fine & irregular pseudopods, immature nuclear features
BM : often unsuccessful
(#14) 52-year-old male, PB Large-cell lymphoma evolving into leukemia
Morphology : Large (> 3 times of RBC), reticular chromatin, deeply basophilic
cytoplasm and 1-3 nucleoli.
Immunophenotype : Clonal B-cell population kappa+, lambda-, CD19+, FMC7+, and negative with CD5, CD23 & CD2.
(#15) 28-year-old male, BMALL-L3, Burkitt’s lymphoma/Burkitt cell leukemia
(#16) 38-year-old black Caribbean Peripheral blood Adult T-cell leukemia lymphoma (ATLL).
Morphology : small to medium size lymphocytes with a highly irregular nucleus with inconspicuous nucleolus and multiple indentation
Immunophenotype : mature T-cell (TdT+, CD1a-, CD2+, CD3+, CD5+, CD7-) with a CD4+, CD8-, CD25+ phenotype.
Antibodies to the human T-cell leukemia/lymphoma virus (HTLV-1)
Molecular analysis : a clonal integration of the proviral HTLV-1 in the cell's DNA
(#17) 2-year-old boy with mediastinal mass
Increasedhematogones
50-55% lymphoid cells with a very high N/C ratio; condensed chromatin, indistinct nucleoli, Some cleft nuclei
CBC : Within normal limits Cell markers : non-B, non-T phenotype Mediastinal mass : plasma cell granuloma. Uneventful recovery from surgery. No follow-up BM study