Abstract

Background: B-cell acute lymphoblastic leukemia is known for heterogeneous blast morphology. Cytoplasmic granules and blebs have both been described, but not together, in lymphoblasts. Case presentation: A 7-year-old boy presented with fever, abdominal distension for 3 weeks, with hepatosplenomegaly. Investigations revealed pancytopenia, peripheral smear showing 21% blasts of varying size, displaying cytoplasmic blebbing and granulation. Marrow aspirate was hemodilute, 10% cells showed dim to moderate expression of CD45, CD10, CD19, HLA-DR confirming B-ALL. Megakaryocytic markers (CD41, CD61) were negative. Marrow biopsy showed a focus of large atypical cells displaying increased nuclear-cytoplasmic ratio, vesicular nuclear chromatin and macronucleoli, reminiscent of diffuse large B-cell lymphoma, cells strongly expressing PAX5, CD19, CD20, and bcl-2.The child was put on standard induction therapy. No blasts were detected in subsequent peripheral smears. Conclusion: To the best of our knowledge, this is the first case of pediatric B-ALL displaying granular “blebbed” blasts.

摘要

背景： B 细胞急性淋巴细胞白血病以原始细胞形态异质性着称。在淋巴母细胞中，细胞质颗粒和泡都被描述过，但没有一起描述过。案例展示: 一名7岁男童因发热、腹胀3周、肝脾肿大就诊。调查显示全血细胞减少，外周涂片显示 21% 的原始细胞大小不一，显示出细胞质出泡和肉芽。骨髓抽吸物是血液稀释液，10% 的细胞显示 CD45、CD10、CD19、HLA-DR 的弱到中度表达，证实 B-ALL。巨核细胞标记物（CD41、CD61）呈阴性。骨髓活检显示一个大的非典型细胞的病灶，显示核质比增加，核染色质和大核仁呈空泡状，让人联想到弥漫性大 B 细胞淋巴瘤，细胞强烈表达 PAX5、CD19、CD20 和 bcl-2。标准诱导治疗。随后的外周血涂片未检测到原始细胞。结论：据我们所知，这是首例显示颗粒状“泡状”母细胞的儿科 B-ALL 病例。