PBL #2 Synthesis

The symptoms presented on the problem all point out acute lymphoblastic
leukemia. Being abrupt on onset of the first symptoms, it is acute. Symptoms related
to depression of marrow function include fatigue due to anemia; fever and night
sweating, reflecting infections secondary to neutropenia; and bleeding due to
thrombocytopenia ( being easily bruised). The mass effects caused by neoplastic
infiltration include the bone pain from marrow expansion and infiltration of the
subperiosteum (thus the tenderness in ankle and shank); generalized
lymphadenopathy (“generalized” if lymph nodes are enlarged in two or more
noncontiguous areas), hepatomegaly and splenomegaly.

Several laboratory procedures should be performed to establish the diagnosis

further. Complete blood count with differential to know : the number of red blood
cells and platelets, the number and type of white blood cells, the amount of
hemoglobin (the protein that carries oxygen) in the red blood cells, the portion of the
blood sample made up of red blood cells (hematocrit). Peripheral blood smear to check
for blast cells, the number and kinds of white blood cells, the number of platelets, and
changes in the shape of blood cells. Bone marrow aspiration and biopsy, the removal
of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the
hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a
microscope to look for abnormal cells.

Acute lymphoblastic leukemia/lymphoma (ALL) are neoplasms composed of

immature B (pre-B) or T (pre-T) cells which are referred to as lymphoblast. In leukemic
presentations, the marrow is hypercellular and packed with lymphoblasts,which
replace the normal marrow elements. Mediastinal thymic masses occur in 50% to 70%
of TALLs, which are also more likely to be associated with lymphadenopathy and
splenomegaly. In both B- and T-ALL, the tumor cells have scant basophilic cytoplasm
and nuclei somewhat larger than those of small lymphocytes. The nuclear chromatin
is delicate and finely stippled, and nucleoli are either absent or inconspicuous. In
many cases the nuclear membrane is deeply subdivided, imparting a convoluted
appearance. In keeping with the aggressive clinical behavior, the mitotic rate is high.
As with other rapidly growing lymphoid tumors, interspersed macrophages ingesting
apoptotic tumor cells may impart a “starry sky” appearance.

Prepared by: Gerald John A. Paz—MT1041

Sources: Robbins and Cotran Pathologic Basis of Disease

Hematology: Clinical Principles and Applications. (Rodak, et.al.)

http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/patient

http://www.aafp.org/afp/1998/1015/p1313.html