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Sharma S, Gaur K, Perme T, Singh A. A Curious Case of Morphologically Deceptive Pediatric B-Lymphoblastic Leukemia with Granular "Blebbed" Blasts and DLBCL-Like Biopsy Findings. Fetal Pediatr Pathol 2023; 42:98-102. [PMID: 35286176 DOI: 10.1080/15513815.2022.2050325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: B-cell acute lymphoblastic leukemia is known for heterogeneous blast morphology. Cytoplasmic granules and blebs have both been described, but not together, in lymphoblasts. Case presentation: A 7-year-old boy presented with fever, abdominal distension for 3 weeks, with hepatosplenomegaly. Investigations revealed pancytopenia, peripheral smear showing 21% blasts of varying size, displaying cytoplasmic blebbing and granulation. Marrow aspirate was hemodilute, 10% cells showed dim to moderate expression of CD45, CD10, CD19, HLA-DR confirming B-ALL. Megakaryocytic markers (CD41, CD61) were negative. Marrow biopsy showed a focus of large atypical cells displaying increased nuclear-cytoplasmic ratio, vesicular nuclear chromatin and macronucleoli, reminiscent of diffuse large B-cell lymphoma, cells strongly expressing PAX5, CD19, CD20, and bcl-2.The child was put on standard induction therapy. No blasts were detected in subsequent peripheral smears. Conclusion: To the best of our knowledge, this is the first case of pediatric B-ALL displaying granular "blebbed" blasts.
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Affiliation(s)
- Sunita Sharma
- Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, Delhi, India
| | - Kavita Gaur
- Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, Delhi, India
| | - Tatton Perme
- Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, Delhi, India
| | - Amrita Singh
- Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, Delhi, India
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Fazio F, Cunsolo G, Mancini F, De Propris MS, Piciocchi A, Arena V, Messina M, Ansuinelli M, Taherinasab AT, Apicella V, Vitale A, Chiaretti S, Guarini A, Del Giudice I, Foà R. Blast morphology in the diagnostic work-up of Ph-like acute lymphoblastic leukemia. Leuk Lymphoma 2022; 63:1512-1514. [PMID: 35133227 DOI: 10.1080/10428194.2022.2032035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Francesca Fazio
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Gabriella Cunsolo
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Francesca Mancini
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Maria Stefania De Propris
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | - Monica Messina
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy.,GIMEMA Data Center, Rome, Italy
| | - Michela Ansuinelli
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | | | - Valerio Apicella
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Antonella Vitale
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Sabina Chiaretti
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Del Giudice
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Robin Foà
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
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