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- Title
UNUSUAL PRESENTATION OF PRECURSOR B-CELL LYMPHOBLASTIC LYMPHOMA/LEUKEMIA WITH EXTENSIVE LYTIC BONE LESIONS.
- Authors
Roy, Suvra; Showalter, Josh; Wahed, Amer; Brown, Robert E.; Buryanek, Jamie
- Abstract
Precursor B cell-lymphoblastic lymphoma/leukemia (B-cell LBL) is only 10-20% of lymphoblastic leukemia group, where majority are T-cell type. Precursor T-cell lymphoblastic leukemia mostly involves the lymph nodes and mediastinum while precursor B-cell lymphoblastic lymphoma usually involves skin and lymph nodes.1,2 However, isolated bone lesion as an initial presentation is rare. Here we present a 10-year-old girl who presented with left distal femur fractures. MRI with contrast showed extensive multifocal lytic lesions. Bone marrow examination showed approximately 3% blasts (by morphology and flow cytometry), rare atypical cells with high nuclear to cytoplasmic ratio and folded nucleus. Flow cytometry was negative for any abnormal immunophenotypes. Bone core biopsy was performed and demonstrated small blue cells that were immunohistochemically positive for TdT, CD79a and PAX5 with Ki-67 expression in 90% of the cells. EZH2 (Enhancer of zeste homolog 2) also strongly expressed in the TdT positive areas. Following histopathological and immunohistochemical examination, diagnosis of precursor B-cell lymphoblastic leukemia was made. This case is unusual given the rarity of Bcell LBL with primary lytic bone lesion as an initial presentation.
- Publication
Canadian Journal of Pathology, 2017, Vol 9, Issue 1, p74
- ISSN
1918-915X
- Publication type
Article