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1、leukemia,Leukemia,Definition: A group of malignant clonal malignant disease of hematopoietic tissue . Blockage of cell differentation in different stages. Accumulation of leukemic cells in bone marrow or other organs. Impaired production of normal blood cells.,Progenitor cell,Stem cell,Normobalst 原红
2、,Basophilic normoblast 早幼红,Polychromatic normoblast 中幼红,Ortho-chromatic normoblast 晚幼红,Myeloblast 原粒,Promyelocyte 早幼粒,Myelocyte 中幼粒,Metamyelocyte 晚幼粒,band cell 杆状核,Segmented cell 分叶核,Monoblast 原单,Promonocyte幼单核,Monocyte 单核,Lymphoblast 原淋,Prolymphocyte 幼淋,Lymphocyte 成熟淋,Lymphocyte 成熟淋,Megakaryoblast
3、原巨核,Promegakaryocyte 幼巨核,Granular megakaryocyte 颗粒巨核,Platelate-forming megakaryocyte产板巨核,Category of Leukemia,Acute Lymphoblastic Leukemia(ALL) Acute Leukemia Acute Myeloid Leukemia(AML) Chronic Myeloid Leukemia(CML) Chronic Leukemia Chronic Lymphocytic Leukemia(CLL),Acute myelogenous leukemia (AML)
4、,Acute myelogenous leukemia (AML) is a clonal malignant disease of hematopoietic tissues that is characterized by accumulation of abnormal leukemic blast cells, principally in the marrow and impaired production of normal blood cells. Thus, the leukemic cell infiltration in marrow is accompanied, nea
5、rly invariably, by anemia and thrombocytopenia. The absolute neutrophil count may be low or normal, depending on the total white cell count.,Incidence of AML,Age adjusted incidence 3.6 per 100,000. Median age at diagnosis: 66 years. Lifetime risk of a diagnosis of AML: 0.39% of people born now.,Nati
6、onal Cancer Institute.SEER Stat Sheets: Acute Myeloid Leukemia. http:/seer.cancer.gov/statfacts/html/amyl.html,Age distribution of AML,Age distribution of ALL,Incidence of Leukemia,In China: Acute Leukemia Chronic Leukemia Adult: AML ALL Children: ALL AML,Etiology of Leukemia,Virus: HTLV-I, HTLV-II,
7、 EB Ionizing Radiation: Atomic bomb exposure Chemical Agents: Benzene; cytotoxic drugs chloramphenicol(氯霉素); phenylbutazone(保泰松). Hereditary Factors: Down syndrome, 21trisomy(三体),ACUTE LEUKEMIA,FAB classification of ALL,L1: small lymphoblastic type L2: large lymphoblastic type L3: large lymphoblasti
8、c type with prominent cytoplasmic vacuolization,Acute Lymphocytic leukemia (L1) The blast cells have a high nucleocytoplasmic ratio, lack visible nucleoli and are relative small.,Acute Lymphocytic Leukemia(L2) The blast cells are mainly large and have one or two prominent nucleoli, which range in si
9、ze from small to large.,Acute Lymphocytic Leukemia (L3) The blast cells have prominent cytoplasmic basophilia and are heavily vacuolated,FAB classification of AML,M0:Acute Myelocytic leukemia with minimally differentiation M1: Acute Myeloblastic Leukemia (without maturation) M2: Acute Myeloblastic L
10、eukemia(with maturation,M2a,M2b) M3: Acute Promyelocytic Leukemia(M3a,M3b) M4: Acute Myelomonocytic Leukemia(M4a,M4b,M4c,M4EO) M5: Acute Monocytic Leukemia(M5a,M5b) M6: Acute Erythroleukemia M7: Acute Megakaryoblastic Leukemia,FAB M0 type. Blast cells with no evident features of differentiation and
11、with negative reactions for Sudan black B and myeloperoxidase. On immunophenotypic analysis, all B and T markers were negative but there was expression of CD13 , CD33. and CD34.,FAB M1 type. Blast cells are small to medium in size with a high nucleocytoplasmic ratio and one of them contains an Auer
12、rod. Sudan black B and peroxidase reactions were positive. Peripheral blood film.,Auer rod,FAB M2 type. There is differentiation to promyelocytes and there is one neutrophil and a blast cell containing an Auer rod. Bone marrow film.,FAB M3 type. Blast cells are in a minority, the dominant cell being
13、 a hypergranular promyelocytes, some with bundles of Auer rods. Bone marrow film,Auer rods,FAB M4 category. There are some blasts showing granulocytic differentiation and others showing monocytic differentiation. Granulocytic differentiation is more obvious in the bone marrow (left) and monocytic in
14、 the peripheral blood (right). Bone marrow and periphera lfilm.,FAB M4 category, with eosinophilic differentiation. This category of AML is often referred to as M4EO AML. There are mature eosinophils and eosinophil precursors. The latter have large pro-eosinophilic granules, which have basophilic st
15、aining characteristics. Bone marrow film.,left,right,FAB M5a category. The blasts are large with abundant cytoplasm. They show little signs of differentiation, but one cell has an indented nucleus. Nucleoli are large and prominent. Sometimes there are fine azurophilic(嗜苯胺蓝颗粒) granules. Bone marrow f
16、ilm.,FAB M5b category. Monocytic differentiation is apparent. Bone marrow film.,FAB M6 showing erythropoiesis that is dysplastic and grossly megaloblastic(巨幼红细胞); there is an excess of proerythroblasts but also of immature granulocytes, including blast cells. Bone marrow film.,FAB M7 category. Bonemarrow trephine biopsy shows blast cells (left) and increased reticulin deposition (right).,Flow chart showing how the WHO hierarchical classification is applied.,AML的WHO分型,伴有再现性
