Leukemias

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Leukemias
Dr.S.P.Sinhasan
Asst.Professor Pathology PESIMSR
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Topics

• Leucopoiesis, Leukemia Definition,
  Classification, FAB/WHO sub classification.
• Acute Leukemia Clinical Features, Morphology,
  Lab Diagnosis
• Chronic Myeloproliferative disorders CML,
  Leukaemoid reaction, CLL
• Plasma Cell Disorders

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Leucopoiesis

• Myeloblast
• Promyelocyte
• Myelocyte
• Metamyelocyte
• Band Neutrophil
• Segmented Neutrophil.

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Myeloblast

• Large cell, with Increased NC ratio, having open
  chromatin (Sieved appearance), Prominent 3-5
  nucleoli, Moderate amount of cytoplasm with
  Granules and Auer Rods.
• MPO Sudan Black Positive.

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acute leukemia, myeloperoxidase stain
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Lymphoblast

• Large cell, with Condensed chromatin, increased
  NC ratio, 0-1 inconspicuous nucleoli, very
  scant amount of agranular cytoplasm (Naked
  nucleus).
• PAS-positive.

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Myeloblast
Lymphoblast
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Promyelocyte

• Largest cell of myeloid series, having large
  nucleus, increased NC ratio, prominent 2-4
  nucleoli, abundant granular cytoplasm, many Auer
  Rods.

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Myelocyte

• Large cell, having Half-moon shaped Nucleus,
  granular abundant cytoplasm.

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Metamyelocyte

• Large Cell with indented nucleus, having abundant
  cytoplasm.

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Mature Neutrophil
Myeloblast
Myelocyte
Metamyelocyte
Promyelocyte
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Myelocyte
Myeloblast
Mature Neutrophil
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Leukemia--Definition

• Lymphoid Neoplasm that presents with widespread
  involvement of the bone-marrow, usually
  accompanied by the presence of large no. of tumor
  cells in the peripheral blood smear.
• Lymphomas- lymphoid neoplasm presenting as
  discrete tissue masses.
• No clear-cut line between leukemias and
  Lymphomas.

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• Progressive neoplastic disease of the hemopoetic
  system.
• Unregulated proliferation of uncommitted or
  partially committed stem cells.
• Heterogeneous group of neoplasms- cell of origin,
  aggressiveness, response to treatment etc.
• Progressive increase in the infiltration of bone
  marrow.

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Lymphoproliferative Disorders
Distinct

• Hodgkins Lymphomas.

• Plasma Cell neoplasms (Myeloma)

Indistinct

• Non-Hodgkins Lymphomas.
• Leukemias.
• Leukemia- Lymphoma process.

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Clinical Presentations

• NHL- 70 cases presents as LN enlargement.
• HD- 100 presents as LN enlargement.
• NHL -30 arise from extranodal sites- skin,
  stomach, Brain.., etc.,
• Leukemias- presents with signs and symptoms
  related to suppression of hematopoisis.
• Lymphocytic leukemias- infiltrate and enlarge the
  spleen and liver.
• Plasma cell neoplasms presents with bone
  destruction. Path .

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Classification of Leukemias

• Acute
• Lymphocytic / Myeloid. (ALL/AML)
• Chronic
• Lymphocytic / Myeloid. (CLL/CML)

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Classification

• Clinically Acute, chronic
• Morphology Myeloid, Lymphoid
• Till now classification followed was FAB.
• Now since 2000 there is WHO classification of
  hemopoetic neoplasms.

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WHO CLASSIFICATION OF NEOPLASTIC DISEASES OF
HEMOPOETIC AND LYMPHOID TISSUES-2000
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WHO CLASSIFICATION OF MYELOID NEOPLASMS 2000

• Chronic myeloproliferative disorders (CMPD)
• Myelodysplastic / myeloproliferative diseases
  (MDS/MPD)
• Myelodysplastic syndromes (MDS)
• Acute myeloid leukemias (AML)

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CHRONIC MYELOPROLIFERATIVE DISORDERS (CMPD)

• Chronic Myeloid Leukemia (CML)
• Chr. Neutrophilic Leukemia
• Chr. Eosinophilic Leukemia
• Polycythemia Vera (PV)
• Chr. Idiopathic Myelofibrosis (MF)
• Essential Thrombocythemia (ET)
• CMPD- Unclassified

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MYELODYSPLASTIC / MYELOPROLEFERATIVE DISEASES
(MDS/MPD)

• Chronic Myelomonocytic Leukemia (CMML)
• Atypical CML
• Juvenile Myelomonocytic Leukemia (JMML)
• MDS / MPD- Unclassified

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MYELODYSPLASTIC SYNDROMES (MDS)

• Refractory Anemia (RA)
• Refractory Anemia with Ringed Sideroblasts
  (RA-RS)
• Refractory Cytopenia with Multilineage Dysplasia
  (RCMD)
• Refractory Anemia with Excess Blasts
• MDS with 5q del Syndrome
• MDS- Unclassified

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Drawbacks

• Many disorders not fitting into one criteria.
• New advances in understanding of cells,
  immunology and genetics.
• Advances in molecular biology.
• There was a need for a new classification.

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AML FAB classification

• M0- Minimally differentiated AML
• M1- AML without maturation
• M2- AML with maturation
• M3- Acute Promyelocytic Leukemia
• M4- Acute Myelomonocytic Leukemia
• M5- Acute Monocytic Leukemia
• M6- Acute Erythroleukemia
• M7- Acute Megakaryocytic Leukemia

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ALL Types-

• ALL- L1
• ALL- L2
• ALL- L3

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Chronic Myelodysplastic syndromes

• 1. Chronic myeloid leukemia (CML)
• 2. Polycythaemia vera
• 3. Essential thrombocytosis
• 4. Myelofibrosis.

Marrow fibrosis gt Cytopenias
Acute leukemia
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Age Distribution

• ALL- Younger age population 4-10
• AML- Young Adults 15-40
• CML- Older adults 30-60
• CLL- Old age group 50-70

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Acute Leukemias

• Rapid onset
• Rapid progress
• High Mortality
• Plenty of Blasts gt30
• Thrombocytopenia
• ALL-Lymphadenopathy
• AML- Hepatosplenomegaly

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AML
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ALL
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Chronic Leukemias

• Slow onset
• Late presentation
• CML- Splenomegaly
• CLL- asymptomatic/ Lymphadenopathy
• CML- Thrombocytosis
• CLL- Thrombocytopenia.

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Chronic leukemias

• Also divided as Myeloid and lymphoid
• Have indolent course.
• More mature forms are seen in the PS like
  lymphocyte and neutrophil.
• Counts are very high.

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CML
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CLL
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THANK YOU