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General and Systemic Histopathology, C601&C602

    Virtual Slide: A 5 year-old girl comes for a pre-school physical exam.


    		 This 5 year-old girl comes for a pre-school physical exam. Her mother indicates she has been listless, complains of headaches, arm and leg pains. Physical exam reveals a well developed, well nourished pale child. There is slight plenomegaly and hepatomegaly with generalized enlarged lymph nodes. Scattered petechiae are seen on the legs.

    WBC 18 X 103

     

    RBC   2.76

    Tdt = positive

           Percent    Abs

     

    HGB   6.6

    CD10 (Calla) = positive

    NE     6.2        1.08

     

    HCT    19.1

     

    LY     90.5      16.2

     

    MCV    84.4

     

    MO     2.8       0.5

     

    MCH    29.9

     

    EO      0.5       0.1

     

    MCHC  35.5

    Reference values?

    BA        0         0

     

    RDW    17

     

    Immature lymphs

     

    PLT   26 X 103

     

     

     

    MPV   7.4

     
    Click the green box in the smear above to see the slide using the virtual microscope. Describe what you see and then answer the following questions.
    • What features of the lymphocytes suggest they are malignant?
    • What clinical features of this girl suggest this is a leukemia?
    • How do we distinguish ALL form AML?
    • What will the bone marrow show?
    • Would expect the cells to be positive for PH1 chromosome?
    • What treatments exist for this condition?
    • Why should one be cautious of uric acid levels during treatment?
    • Prognostic indicators for this disease?
    Lymphoblasts positive for terminal DNA transferase (Tdt).