Stein P, Peiper S, Butler D, Melvin S, Williams D, Stass S
Am J Clin Pathol. 1983 Apr;79(4):426-30. doi: 10.1093/ajcp/79.4.426.
Granules in blasts are most typical of acute myeloblastic leukemia. However, there have been scattered reports of patients with acute lymphoblastic leukemia (ALL) that have lymphoblasts with azurophilic cytoplasmic granules. These reports do not describe immunologic markers or cytogenetics. We report five additional cases with detailed cytologic, immunologic, and cytogenetic studies. At diagnosis one of these patients had central nervous system disease, while the others had no unusual features. Four of the five patients attained remission. The blasts of all five patients contained distinct cytoplasmic azurophilic granules. The granules were negative for peroxidase and chloroacetate esterase and positive for PAS, acid phosphatase, alpha-naphthyl acetate esterase incompletely fluoride inhibited, alpha-naphthyl butyrate esterase, and in one case, Sudan black B. In the one patient studied by electron microscopy, characteristic lymphoblasts contained membrane-bound electron lucent inclusions, which stained positively with non-specific esterase. Immunologic markers showed a common ALL phenotype. Different cytogenetic abnormalities were seen in all cases. It is important to recognize the characteristics of this morphologic subtype of ALL in order to avoid a misdiagnosis of acute nonlymphocytic leukemia.
原始细胞中的颗粒在急性髓细胞白血病中最为典型。然而，已有关于急性淋巴细胞白血病（ALL）患者的零散报道，这些患者的原始淋巴细胞含有嗜天青细胞质颗粒。这些报道未描述免疫标志物或细胞遗传学情况。我们报告另外5例病例，并进行了详细的细胞学、免疫学和细胞遗传学研究。诊断时，其中1例患者有中枢神经系统疾病，而其他患者无异常特征。5例患者中有4例获得缓解。所有5例患者的原始细胞均含有明显的细胞质嗜天青颗粒。这些颗粒过氧化物酶和氯乙酸酯酶呈阴性，PAS、酸性磷酸酶、不完全被氟化物抑制的α-萘乙酸酯酶、α-萘丁酸酯酶呈阳性，1例患者苏丹黑B呈阳性。在1例接受电子显微镜检查的患者中，特征性原始淋巴细胞含有膜结合的电子透亮包涵体，其非特异性酯酶染色呈阳性。免疫标志物显示为常见的ALL表型。所有病例均可见不同的细胞遗传学异常。认识到ALL这种形态学亚型的特征很重要，以避免误诊为急性非淋巴细胞白血病。
