Granular Acute Lymphoblastic Leukemia Research Articles

Granular B lymphoblastic leukemia.

A 13-year-old Indian boy presented with extreme lethargy and weakness. On examination, there was no hepatosplenomegaly or lymphadenopathy. His blood count showed a white cell count of 18.8 × 109/L, hemoglobin concentration 107 g/L, and platelet count 70 × 109/L. Examination of a blood film led to suspicion of granular lymphoblastic leukemia. There were 60% blast cells with a moderately high nucleocytoplasmic ratio, delicate chromatin, and 1–3 nucleoli. Many of the blast cells contained prominent azurophilic cytoplasmic granules. There were no Auer rods and granulocyte morphology was normal. The suspected lineage was confirmed by flow cytometric immunophenotyping which showed the blast cells to express CD45 (weak), CD34, CD10, CD19, CD20, cytoplasmic(c) CD79a, CD33, and HLA-DR. There was no expression of myeloperoxidase, cCD3, CD7, CD13, CD64, or CD117. Cytogenetic analysis showed a normal male karyotype. Reverse transcriptase for BCR::ABL1 did not detect p210, p190, or p230 transcripts. Granular acute lymphoblastic leukemia (ALL) is uncommon. Making a distinction from acute myeloid and mixed phenotype, acute leukemia is important and requires myeloperoxidase cytochemistry or immunophenotyping. Most cases are pro-B or common ALL but T-lineage cases have also been reported. In addition to B-lineage-specific markers, there can be aberrant expression of CD131 or CD33.2, 3 There is no specific cytogenetic association and the prognostic significance, if any, is uncertain. The authors declare no conflict of interest

A striking view of granular acute lymphoblastic leukemia in cerebrospinal fluid.

A striking view of granular acute lymphoblastic leukemia in cerebrospinal fluid.

B lymphoblastic leukemia with granules mimicking acute myeloid leukemia in a 4 years female child

Granular acute lymphoblastic leukemia [ALL] is a rare morphological variant of ALL characterized by cytoplasmic azurophilic granules or inclusions positive for aspecific esterase and acid phosphatase with heterogeneous features at the ultrastructural level. Granular ALL usually occur in children [2-7%] but is extremely rare in adults. It is important to perform cytochemical staining and flow cytometry to make the distinction between acute myeloid and lymphoblastic leukemia. We review the case history and pathological findings in a 4 years female child with initial cytomorphological diagnosis of AML which after flow cytometry turned out to be granular ALL.

Philadelphia chromosome-positive granular acute lymphoblastic leukemia: report of one case and review of literature

目的 探讨费城染色体阳性（Ph+）颗粒性急性淋巴细胞白血病（G-ALL）的诊断、临床特点及预后。 方法 回顾性分析山东省泰安市中心医院2015年9月诊断为Ph+ G-ALL 1例患者的临床资料，并复习相关文献。 结果 该患者骨髓涂片中含颗粒的原始幼稚淋巴细胞占骨髓原始幼稚淋巴细胞中的23%，免疫表型为急性B淋巴细胞白血病（B-ALL），BCR-ABL融合基因阳性，Ph染色体阳性，骨髓缓解后行异基因造血干细胞移植，目前定期门诊复诊。 结论 成年人G-ALL少见，诊断依据骨髓形态学检查及免疫分型，治疗按照成年人急性淋巴细胞白血病方案，但其诱导缓解率、生存期低于非G-ALL。

Granular acute lymphoblastic leukemia in an adult patient

Granular acute lymphoblastic leukemia (G-ALL) may mimic the diagnosis of acute myeloid leukemia due to the presence of cytoplasmic granules found in the lymphoblasts. This rare variant is commonly seen in children but may occur in adults also. We report a case of G-ALL in an adult female patient.

Granular acute lymphoblastic leukemia: A case report and literature review

Authors report a rare case of granular acute lymphoblastic leukemia (ALL) in a 45-year-old woman with a history of multiple myeloma. The patient's lymphoblasts contained large numbers of distinctive cytoplasmic granules closely mimicking heavily granulated myeloblasts in acute myeloid leukemia. These blasts were completely negative for myeloperoxidase but positive for acid phosphatase and Periodic Acid-Schiff reaction by cytochemical staining. Immunophenotype analysis by immunohistochemistry clearly demonstrated precursor B-cell phenotype. Granular ALL occurs approximately 2 to 7% in childhood populations but is extremely rare in adults. Such cases may cause problematic distinction from myeloid differentiation and lead to misdiagnosis of acute myeloid leukemia. Ten cases of adult granular acute lymphoblastic leukemia described to date in the literature were also reviewed.

Granular Acute Lymphoblastic Leukemia in Adults: Report of a Case and Review of the Literature

The diagnosis of granular acute lymphoblastic leukemia (ALL) can be problematic as the cytoplasmic granules found in many blast cells may mimic those seen in acute myelogenous leukemia (AML). This rare variant of B-cell ALL is more commonly diagnosed in children, but may occur in adults. We report a case of granular B-ALL in a 56-year-old female and review the literature.

Granular Acute Lymphoblastic Leukemia: Report of Two Cases and Review of the Literature

Granular Acute Lymphoblastic Leukemia: Report of Two Cases and Review of the Literature

Laboratory Correlates and Prognostic Significance of Granular Acute Lymphoblastic Leukemia in Children: A Pediatric Oncology Group Study

As part of a comprehensive prospective clinicopathologic study by the Pediatric Oncology Group (POG), 2,092 children with acute lymphoblastic leukemia (ALL) were evaluated by uniform morphologic, cytochemical, and immunologic methods to assess the frequency and implications of granular lymphoblasts. All cases were Sudan black or myeloperoxidase negative and met French-American-British (FAB) morphologic criteria for ALL. Granular ALL, characterized by the presence of more than 5% marrow blasts with at least three clearly defined azurophilic cytoplasmic granules, was identified in 56 of the 1,252 fully studied cases (4.5%). The frequency of granular features did not differ among early pre-B (4.3%), pre-B (3.6%), and T (5.8%) ALL; no cases were identified among the 12 patients with B ALL. Within the early pre-B/pre-B group, granular ALL was equally distributed between good- and poor-risk clinical groups but was more frequent among FAB L2 than FAB L1 cases (12% vs. 2%; P less than or equal to 0.001). Patients were treated with standard POG protocols for early pre-B/pre-B and T ALL. Complete remission (CR) rates were significantly lower for those with granular lymphoblasts, regardless of risk group, immunophenotype, or FAB type. Analysis of event-free survival (EFS) showed a significantly poorer outcome for granular early pre-B/pre-B cases with FAB L2 morphologic characteristics (P less than 0.001) and for those classified as poor risk (P = 0.015). These findings suggest a relationship between granules and L2 morphologic characteristics in childhood ALL and indicate that the presence of granular lymphoblasts conveys a worse prognosis for certain subgroups of children with ALL.