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Acute Leukemias, M7: acute megakaryoblastic leukemia, AML megakaryoblastic…

- - - - M2: AML with maturation
        
        M1: aml w/o maturation
        
        M0: AML mini differentiated
        
        Acute myeloid leukemia, not otherwise specified
        
        more than 20% blasts in PB or Bm
        
        Fab M0:blasts without morphologic differentiations. cannot identify lymphoid or myeloid. <3% MPO activity and SBB neg (Sudan black ). Hypercellular BM, CD 13, 33,117, 38
        
        fab M1: >3% blasts MPO, +_ Auer rods (some blasts have granules), or SBB + d/t variably granules. CD 13,33,117. Hypercellular
        
        Fab M2: can see the mature neutrophil cell line in circulation. MPO, SBB, CE (specific estrate) ARE POSITIVE. (CE: an enzyme that can be detected in granulocytic (myeloid) cells through a specific stain. In hematology, specific esterase stains, like chloroacetate esterase, are used to identify and differentiate myeloid cells, particularly in the diagnosis of leukemias.)
        
        13,15,33,65,11b. azurophilic granues w/wo Auer rods. Frequent Auer rods, blasts with 1 degree granules
        
        10% with myeloid differentiation, < 20% Precursor monocytic lineage in BM, maturation beyond promyelocyte
      - 2 cell line involved myeloid and monocytic.
      - more than 3% MPO, SBB, CE, NSE (represent monocytic cell line.). ARE POSITIVE
      - CD 13,33,14,4, 11b, 11c, 15, 64,36
      - Proliferation of both myeloid and monocytic precursors
- - - - APL：acute promyelocytic leukemia
        
        AML with inversion (16) or t (16;16); CBFB-MYH11
        
        Monocytic and granulocytic differentiation and abnormal eosinophilia (in maturation has 1-35%, immature eosinophilic granulation is mix of eosinophilic and basophilic granules exists)
        
        3% of blast are MPO positive (3% of the immature cells (blasts) tested have myeloperoxidase activity). neutrophils, eosinophils, and myeloblasts, will stain positive for MPO. This helps distinguish between myeloid (MPO-positive) and lymphoid (MPO-negative)
        
        Immunophenotying: CD 34 ( hematopoietic stem cells and early progenitors.), CD 117 (immature hematopoietic cells,). Myeloid markers: CD 13, 33,15,65, MPO. Monocytic differentiation: CD4, CD14, 64,CD11b, 11c and CD 36, lysozyme
        
        AML With t (8;21) translocation. predominant neutrophil differentiation. Occur in children and younger adults. Large blasts with abundant basophilic cytoplasm d/t numerous azurophilic granules-- auer rods.
        
        AML with recurrent genetic abnormalities regardless of blast %.
        
        AML: Clonal proliferation of myeloid blasts in BM, blood or other issue
        
        M:E ration >1. increase in myeloid cells compared to erythroid.
        
        Immunophenotyping: CD 34 (HIGH intensity). CD 13 and 33 weak. CD 15 and CD 65
        
        AML with t (15;17); oncogen is PML/RARa. (also is M3)
        
        The nucleus is not round like the normal promyelocyte. The normal regular promyelocytes have nice and round nucleus. APL: the nucleus is like bowtie, butterfly, coin-on-coin nucleus
        
        Sudan black stain: positive d/t stains the lipid
        
        differentiation block at promyelocyte stage
        
        subtypes
        
        microgranular (hypo) APL: M3v, or M3m: evenly absence of granules, but strong positive MPO. weak of NSE. also may shows Auer rods. Very high WBC with a rapid doubling time
        
        typical APL is hypergranular. M3: irregular nuclear size and shape, kidney shaped or bilobed. Cytoplasm: Faggot cells. Positive MPO, weakly postivie NSE. DIC (granule initiate DICs)
        
        BM is hypercellular
        
        Myeloid markers: CD 33, CD 13. Strong MPO. Lymphoid markers: coexpression CD2 and CD 19.
        Cytogenetics: 17q12- RARa, 15q22--PML. FLT3-ITD mutation accompany to increase WBC count.
      - MLLT3-MLL or AML with 11q23. Associated with monocytic -- Monoblasts and promonocytes
      - DIC and gingival bleed, sarcomas
      - CD 14, CD4, CD64
      - Cytochemistry: strong positive non-specific esterase reactions.
- - - - Cytochemistry: MPO negative (*mpo only in the primary granule of myeloid cell) , PAS (+)
        
        Immunophenotyping: most cases: CD10, CD22 , 24, Tdt, CD 19,
- - - - SBB
        
        MPO
        
        Neutrophil first granule: myeloblast ++, monoblasts +
        
        Phospholipids: myeloblast ++, monoblasts +
      - cellular enzyme: myeloblast ++