Ana-Maria Vladareanu

Acute Lymphocytic Leukemia in Adults. Pathologic Features and Prognosis

Abstract Acute lymphoblastic leukemia (ALL) is a malignant neoplasm of the lymphocyte precursor cells. Among adults it is a relatively rare neoplasm with a curability rate around 30% at 5 years. Currently, the diagnosis and classification of ALL is a multistep procedure that relies on the simultaneous application of multiple techniques that include: cytomorphology, immunophenotype and cytogenetic assays . Some of which have important clinical implications for both diagnosis and predicting response to specific treatment regimens, while the role of others is still to be defined. Over the years, several prognostic factors have been identified and today a risk stratification at diagnosis and during the follow -up is based on the characteristics of the leukemic cells. Abstract Leucemia acută limfoblastică (ALL) este o neoplazie malignă a celulelor precursoare limfoide. În rândul adulţilor, este o neoplazie relativ rară cu o rată de curabilitate la 5 ani în jur de 30%. Actualmente, diagnosticul şi clasificarea ALL este o procedură ce presupune mai multe etape care se bazează pe aplicarea simultană de tehnici multiple ce includ: examinări citomorfologice, imunofenotipice şi citogenetice. Unele dintre ele au o implicare clinică importantă atât în diagnostic cât şi în estimarea răspunsului la regimurile de tratament specific, în timp ce rolul celorlalte rămâne să fie definit. De-alungul anilor, au fost identificaţi anumiţi factori de risc, iar astăzi, caracterizarea celulei leucemice stă la baza stratificării riscului la diagnostic şi în timpul evoluţiei bolii.

Lymphoma immunophenotyping: “borderline” lymphomas

Immunophenotyping of B‐cell lymphoproliferative disorders is indispensable, especially in disorders with CD19(+) CD5(+) B lymphocytes, where we have to make the distinction between low grade neoplasia, such as chronic lymphocytic leukemia with CD23(+) malignant lymphocytes, and aggressive neoplasia such as mantle cell lymphoma with CD23(‐) malignant lymphocytes. We found some cases of CD19(+) CD5(+) lymphoproliferative disorders that do not meet all criteria for diagnosis of chronic lymphocytic leukemia or mantle cell lymphoma. For instance, we found cases with a low or no expression of CD23, asociated with absence of expression of FMC7 and surface immunoglobulins. These cases could be classified as “borderline” CD19(+) CD5(+) B cell lymphoproliferative disorders, with an intermediate neoplasic grade.