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?

    Next patient is a woman with a positive hemoccult test.

    Lymphoblasts positive for terminal DNA transferase (Tdt).

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