HEMATOPOIETIC NEOPLASMS

LEUKEMIAS
 Hematopoietic neoplasms

Hematopoietic neoplasms

Histiocytic & dendritic

Myeloid Lymphoid cell neoplasms

neoplasms neoplasms
Hematopoietic neoplasms
Hematopoietic neoplasms

Myeloid Lymphoid
neoplasms neoplasms

Myeloproliferative neoplasms

Myelodysplastic syndromes

Acute myeloid leukemia

 Hematopoietic neoplasms
Hematopoietic neoplasms

Myeloid Lymphoid
neoplasms neoplasms

Precursor lymphoid neoplasms

Mature lymphoid neoplasms

 Hematopoietic neoplasms
Hematopoietic neoplasms

Myeloid Lymphoid
neoplasms neoplasms

Precursor lymphoid Mature lymphoid

neoplasms neoplasms

B cell B cell

T cell T (& NK) cell

 Hematopoietic neoplasms
Hematopoietic neoplasms

Lymphoid
neoplasms

Precursor lymphoid neoplasms Mature lymphoid neoplasms

B lymphoblastic
leukemia/lymphoma B cell

T lymphoblastic
leukemia/lymphoma T cell
 Hematopoietic neoplasms
Lymphoid
Hematopoietic neoplasms

neoplasms
Precursor lymphoid Mature lymphoid
neoplasms neoplasms
B cell T cell
B lymphoblastic
leukemia/lymphoma Non Hodgkin
lymphoma

T lymphoblastic Hodgkin
leukemia/lymphoma lymphoma
Hematopoietic neoplasms
Hematopoietic neoplasms

Myeloid Lymphoid
neoplasms neoplasms

Myeloproliferative neoplasms

Chronic myeloid leukemia

Myelodysplastic syndromes

Acute myeloid leukemia

 Hematopoietic neoplasms
Hematopoietic neoplasms

Precursor lymphoid neoplasms

(Acute lymphoblastic leukemia)

B lymphoblastic leukemia/lymphoma

T lymphoblastic leukemia/lymphoma
 Hematopoietic neoplasms
Hematopoietic neoplasms

Mature lymphoid
neoplasms
B cell T cell

Non Hodgkin Hodgkin

lymphomas lymphomas

Chronic lymphocytic
leukemia/Small lymphocytic (ATCL)
lymphoma
…
…
 Hematopoietic neoplasms

• Neoplastic cells resemble normal stages of

differentiation and recapitulate the behavior
of their normal counterparts
– Routine methods
– Special stains
– Immunological identification
Hematopoietic neoplasms
Hematopoietic neoplasms
•TdT

•Sig

•CD34

•CD10
•CD19
•CD20
•CD21
•CD22

•CD1
•CD2
•CD3
•CD4
•CD5
•CD7
•CD8
Hematopoietic neoplasms
 Hematopoietic neoplasms

• Non random chromosomal abnormalities are

common
– Translocations
• Recognized etiologic agents
– Genetic factors
• Down syndrome, neurofibromatosis type I
• Fanconi anemia
– Viral infections, bacterial infection
– Environmental agents
– Iatrogenic factors
Hematopoietic neoplasms
•TdT

•CD34

•Sig

•CD10
•CD19
•CD20
•CD21
•CD22

•CD1
•CD2
•CD3
•CD4
•CD5
•CD7
•CD8
 Hematopoietic neoplasms

• Leukemia
– Bone marrow + peripheral blood
– Diffuse
• Lymphoma
– Discrete tissue mass
• Lymph node
• Extra nodal tissues
 Acute leukemias

• Accumulation of blasts in the bone marrow

• Suppression of normal hematopoiesis
• Abrupt onset
– Anemia – fatigue
– Neutropenia – fever
– Thrombocytopenia – bleeding (petechiae,
ecchymoses, epistaxis, gum bleeding)
– Bone marrow expansion – bone pain
Acute leukemias
 Acute leukemias

– ↑WBC count

• Manifestations more common in ALL

– Generalized lymphadenopathy
– Hepatomegaly and splenomegaly
– CNS involvement – headache, vomiting, cranial
nerve palsies
– Testicular involvement
Hematopoietic neoplasms
Hematopoietic neoplasms

Myeloid Lymphoid
neoplasms neoplasms

Myeloproliferative neoplasms

Chronic myeloid leukemia

Myelodysplastic syndromes

Acute myeloid leukemia

 Hematopoietic neoplasms
Hematopoietic neoplasms

Precursor lymphoid neoplasms

(Acute lymphoblastic leukemia)

B lymphoblastic leukemia/lymphoma

T lymphoblastic leukemia/lymphoma
 Acute lymphoblastic leukemia
– B lymphoblastic leukemia/lymphaoma
– T lymphoblastic leukemia/lymphoma

– Epidemiology
• Age
– Most <15yrs
• Sex
• Race
– Whites
 Acute lymphoblastic leukemia

– Abrupt onset of anemia, neutropenia,

thrombocytopenia
– Bone pain & tenderness
– Lymphadenopathy, hepatosplenomegaly
– CNS manifestations
 Acute lymphoblastic leukemia

• Pre-B ALL • Pre-T ALL

– 85% – less common
– Peak age – 4yrs – Peak age – adolescence
– Bone marrow and – Mediastinal /thymic
peripheral blood involvement more
– Lymphoblasts common
– Lymphadenopathy,
splenomegaly more
common
– Lymphoblasts
 Acute lymphoblastic leukemia

• Lymphoblast
Lymphoblasts
Nuclei round-oval nuclei with coarse chromatin
chromatin tends to aggregate into masses
Nucleoli usually small and inconspicuous
Cytoplasm basophilic, sparse in volume, usually without granules (rare non-
specific granules). Auer rods are never observed.

– Subtypes
• L1 L2

http://www.med-ed.virginia.edu/courses/path/innes/
 Acute lymphoblastic leukemia

• Immunophenotype
– TdT
– CD19, CD10 – Pre-B
– CD1, CD2; CD3, CD4/CD8 – Pre-T
• Cytogenetics
– Hyperploidy, polyploidy
– t(12;21), t(9;22), t(4;11)
 Acute myeloid leukemia
– Adults (peak 15-39)
– Heterogenous
• FAB -- M0 – M7
– Easy fatiguability, infections, bleeding
– Mild lymphadenopathy, organomegaly

– Localized mass – ‘granulocytic sarcoma’

 Acute myeloid leukemia

• Revised FAB (French-American-British) classification

– Acute myeloid leukemia, minimally differentiated (M0)
– Acute myeloid leukemia without maturation (M1)
– Acute myeloid leukemia with maturation (M2)
– Acute promyelocytic leukemia (M3)
– Acute myelomonocytic leukemia (M4)
– Acute monoblastic and monocytic leukemia (M5)
– Acute erythroid leukemia (M6)
– Acute megakaryoblastic leukemia (M7)
 Acute myeloid leukemia
– AML with recurrent genetic abnormalities
– AML with myelodysplasia-related changes
– Thearpay-related myeloid neoplasms
– AML, not otherwise specified
• Acute myeloid leukemia, minimally differentiated (M0)
• Acute myeloid leukemia without maturation (M1)
• Acute myeloid leukemia with maturation (M2)
• Acute promyelocytic leukemia (M3)
• Acute myelomonocytic leukemia (M4)
• Acute monoblastic and monocytic leukemia (M5)
• Acute erythroid leukemia (M6)
• Acute megakaryoblastic leukemia (M7)
– Myeloid sarcoma
 Acute myeloid leukemia

• Morphology
– Peripheral blood
• WBC < 10,000 ---- > 100,000 due to circulating blasts
and other immature myeloid cells
• Hypogranular and hyposegmented neutrophils, large
atypical platelets
• Aleukemic leukemia (peripheral blood lacks blasts)
– Bone marrow
• ≥20% blasts
 Acute myeloid leukemia

• Morphology
– Fine, delicate chromatin
– Prominent nucleoli
– Cytoplasm
• Moderate
• Lightly basophilic
• ± granules
• ± Auer rods
ALL Vs AML
 Chronic myelogenous leukemia
• BCR-ABL fusion gene, t(9;22)
– Philadelphia chromosome
• Pluripotent stem cell

• Peak incidence – 4th & 5th decades

• Gradual onset of non specific symptoms
• Left upper quadrant pain
 Chronic myelogenous leukemia

• BCR-ABL fusion gene, t(9;22)

– Philadelphia chromosome
 Chronic myelogenous leukemia

• Morphology
– Marrow
• Increased cellularity
• Maturing granulocytic precursors
• Sea-blue histiocytes
– Peripheral blood
• Leukocytosis >100,000/μL
• Neutrophils, metamyelocytes, myelocytes
• Eosinophils, basophils
– Splenomegaly
 Chronic myelogenous leukemia

• Clinical course
– Chronic phase
• Av. 3 years
– Accelerated phase
• 6-12 mths
• Increasing anemia and thrombocytopenia
– Blast crisis
• Majority - myeloblasts
 Chronic myelogenous leukemia

Frontiers in Bioscience 11, 209-220, January 1,

2006
 Chronic lymphocytic leukemia/ Small
lymphocytic lymphoma
• CLL
– Absolute lymphocyte count >4,000

– Clinical features
• Median age 60
• Asymptomatic/non specific symptoms
• Hypogammaglobulinemia
• Serum M protein
• Autoantibodies

– Transformation
• Prolymphocytic
• Diffuse large B cell lymphoma
Chronic lymphocytic leukemia/ Small
lymphocytic lymphoma
Chronic lymphocytic leukemia/ Small
lymphocytic lymphoma