Abstract
Biphenotypic acute leukemia (BAL) is an uncommon clinical entity. It is a type of acute leukemia with features characteristic of both the myeloid and lymphoid lineages and for this reason is designated as mixed-lineage, hybrid or biphenotypic acute leukemia. As strict diagnostic criteria have only recently been established, the precise incidence among acute leukemia is uncertain, although it is likely to account for approximately less then 5% of all acute leukemia. BAL is now collectively considered as “mixed phenotype acute leukemia” (MPAL). We hereby report two cases of a rare disease, BAL from our institution in the light of morphology, cytochemistry, flow cytometry and review of literature regarding these cases are described.
Highlights
Diagnosis and classification of acute leukemia depend on morphology, cytochemistry, immunophenotype, cytogenetic and molecular analyses
Biphenotypic acute leukemia (BAL) is an uncommon clinical entity. It is a type of acute leukemia with features characteristic of both the myeloid and lymphoid lineages and for this reason is designated as mixed-lineage, hybrid or biphenotypic acute leukemia
We describe two cases of BAL from our institution in the light of morphology, cytochemistry and flow cytometyric immunophenotyping
Summary
Diagnosis and classification of acute leukemia depend on morphology, cytochemistry, immunophenotype, cytogenetic and molecular analyses. The examination of the pheripheral blood or bone marrow aspirate and various cytochemical stains, in most of the cases can distinguish lymphoblasts from myeloblasts. In acute leukemia blast cells frequently express markers of a single cell line (lineage fidelity) and a variable number of cases, an aberrant antigen expression can be found (lineage infidelity). While immunophenotyping is being routinely done to classify acute leukemia, a simple observation of presence of morphologically two distinct variants of blasts in the peripheral blood or bone marrow aspirate may serve as the key to the diagnosis of most cases. A simple myeloperoxidase staining and its positivity in more than 3% of blasts in the bone marrow may lead to a diagnosis of AML by FAB criteria, so the probability of under diagnosis of BAL cannot be ignored if the facility for immunophenotyping is not available. We describe two cases of BAL from our institution in the light of morphology, cytochemistry and flow cytometyric immunophenotyping
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