Nguyen D, Brynes R K, Macaulay L, Kaplan B, Pinter-Brown L C
Department of Pathology Clinical Hematology, Los Angeles County - USC Medical Center.
Hematol Pathol. 1989;3(1):11-22.
Acute leukemia was diagnosed in 62 adults and children over a recent 13-month period. Using light microscopy, cytochemical profiles, surface markers, and cytogenetics, 25 cases were classified as acute myeloid leukemia (AML) and 32 as acute lymphoblastic leukemia (ALL). The remaining 5 cases of de novo acute leukemia were unclassifiable. The routine cytochemical battery used on these 62 cases included: myeloperoxidase, sudan black B, nonspecific esterase, and periodic acid-Schiff (PAS). Flow markers utilized were: T3, T4, T5, T8, T10, T11, B1, B4, kappa, lambda, Ia, CALLA, Mo1, Mo2, My4, My7, My8, and My9. TdT was performed by immunoperoxidase and ELISA methods. The five unclassified cases were cytochemically negative and expressed no B- or T-cell-specific antigens, or TdT positivity. The morphologic differential diagnosis was between FAB L-2 and M-1. Karyotypic abnormalities involving chromosomes 3 and 7 were suggestive of myeloid origin in 2 of 4 patients studied. Flow cytometry demonstrated My7 on greater than 50% of blasts from two cases. Myeloperoxidase ultracytochemistry showed reaction product in small primary granules of blasts from all 5 cases. Positive cells contained only 1-2 granules/cell profile. The number of positive cells per case was in the range 10-20%. We conclude from this study that ultracytochemistry is very useful in providing definitive diagnosis and accurate subclassification of some AML FAB M-1 cases, particularly when light microscopic cytochemistry, cytogenetics, and flow cytometric markers are noncontributory. We propose to designate these acute "unclassified" leukemias as AML FAB M-1 "microgranular" type.
在最近13个月期间，62名成人和儿童被诊断出患有急性白血病。通过光学显微镜、细胞化学特征、表面标志物和细胞遗传学分析，25例被归类为急性髓细胞白血病（AML），32例为急性淋巴细胞白血病（ALL）。其余5例原发性急性白血病无法分类。对这62例患者使用的常规细胞化学检测包括：髓过氧化物酶、苏丹黑B、非特异性酯酶和过碘酸希夫（PAS）染色。所使用的流式细胞标志物有：T3、T4、T5、T8、T10、T11、B1、B4、κ、λ、Ia、CALLA、Mo1、Mo2、My4、My7、My8和My9。末端脱氧核苷酸转移酶（TdT）通过免疫过氧化物酶法和酶联免疫吸附测定法检测。这5例无法分类的病例细胞化学检测呈阴性，且不表达B或T细胞特异性抗原，也没有TdT阳性。形态学鉴别诊断在FAB L - 2和M - 1之间。在研究的4例患者中，2例涉及3号和7号染色体的核型异常提示髓系起源。流式细胞术显示，2例患者超过50%的原始细胞表达My7。髓过氧化物酶超微细胞化学显示，所有5例患者原始细胞的小初级颗粒中有反应产物。阳性细胞每个细胞轮廓仅含1 - 2个颗粒。每例阳性细胞数量在10% - 20%范围内。我们从这项研究得出结论，超微细胞化学对于某些AML FAB M - 1病例的明确诊断和准确亚分类非常有用，特别是在光学显微镜细胞化学、细胞遗传学和流式细胞术标志物无诊断价值时。我们建议将这些急性“未分类”白血病指定为AML FAB M - 1“微颗粒”型。
