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Acute leukemias of ambiguous origin

Porwit, Anna LU and Béné, Marie C. (2015) In American Journal of Clinical Pathology 144(3). p.361-376
Abstract

Objectives: This session of the Society for Hematopathology/ European Association for Haematopathology Workshop focused on acute leukemias of ambiguous origin. Methods: We provide an overview of mixed-phenotype acute leukemia (MPAL) as recognized in the current World Health Organization classification and summarize diagnostic criteria for major categories of MPAL: B/myeloid, T/myeloid, B/T, and B/T/myeloid. Results: Most MPAL cases submitted were B/myeloid and T/myeloid MPAL, the most frequent types, but three cases of B/T MPAL were also submitted, and examples of all categories are illustrated. We emphasize that a comprehensive approach to immunophenotyping is required to accurately establish the diagnosis of MPAL. Flow cytometry... (More)

Objectives: This session of the Society for Hematopathology/ European Association for Haematopathology Workshop focused on acute leukemias of ambiguous origin. Methods: We provide an overview of mixed-phenotype acute leukemia (MPAL) as recognized in the current World Health Organization classification and summarize diagnostic criteria for major categories of MPAL: B/myeloid, T/myeloid, B/T, and B/T/myeloid. Results: Most MPAL cases submitted were B/myeloid and T/myeloid MPAL, the most frequent types, but three cases of B/T MPAL were also submitted, and examples of all categories are illustrated. We emphasize that a comprehensive approach to immunophenotyping is required to accurately establish the diagnosis of MPAL. Flow cytometry immunophenotyping using a large panel of antibodies is needed as well as confirmatory immunohistochemical analysis and cytochemistry studies for myeloperoxidase and nonspecific esterase. We discuss technical issues in determining blast lineage and possible pitfalls in MPAL diagnosis. In particular, rare cases of B-acute lymphoblastic leukemia (B-ALL) can express myeloperoxidase but are otherwise consistent with B-ALL and should be treated as such. Last, we review the differential diagnosis between acute undifferentiated leukemia and acute myeloid leukemia with minimal differentiation. Conclusions: There was an agreement that diagnosis of MPAL can be challenging, especially if applied flow cytometry panels are not comprehensive enough.

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author
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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute leukemia, Immunophenotype, Lineage, Lymphoid, Mixed phenotype acute leukemia, Myeloid, Undifferentiated acute leukemia
in
American Journal of Clinical Pathology
volume
144
issue
3
pages
16 pages
publisher
Oxford University Press
external identifiers
  • pmid:26276768
  • scopus:84946715911
ISSN
0002-9173
DOI
10.1309/AJCPSTU55DRQEGTE
language
English
LU publication?
no
id
64d42c44-ec1f-48fc-8299-8ff3c236f38c
date added to LUP
2019-05-22 09:42:30
date last changed
2024-07-09 14:34:07
@article{64d42c44-ec1f-48fc-8299-8ff3c236f38c,
  abstract     = {{<p>Objectives: This session of the Society for Hematopathology/ European Association for Haematopathology Workshop focused on acute leukemias of ambiguous origin. Methods: We provide an overview of mixed-phenotype acute leukemia (MPAL) as recognized in the current World Health Organization classification and summarize diagnostic criteria for major categories of MPAL: B/myeloid, T/myeloid, B/T, and B/T/myeloid. Results: Most MPAL cases submitted were B/myeloid and T/myeloid MPAL, the most frequent types, but three cases of B/T MPAL were also submitted, and examples of all categories are illustrated. We emphasize that a comprehensive approach to immunophenotyping is required to accurately establish the diagnosis of MPAL. Flow cytometry immunophenotyping using a large panel of antibodies is needed as well as confirmatory immunohistochemical analysis and cytochemistry studies for myeloperoxidase and nonspecific esterase. We discuss technical issues in determining blast lineage and possible pitfalls in MPAL diagnosis. In particular, rare cases of B-acute lymphoblastic leukemia (B-ALL) can express myeloperoxidase but are otherwise consistent with B-ALL and should be treated as such. Last, we review the differential diagnosis between acute undifferentiated leukemia and acute myeloid leukemia with minimal differentiation. Conclusions: There was an agreement that diagnosis of MPAL can be challenging, especially if applied flow cytometry panels are not comprehensive enough.</p>}},
  author       = {{Porwit, Anna and Béné, Marie C.}},
  issn         = {{0002-9173}},
  keywords     = {{Acute leukemia; Immunophenotype; Lineage; Lymphoid; Mixed phenotype acute leukemia; Myeloid; Undifferentiated acute leukemia}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{3}},
  pages        = {{361--376}},
  publisher    = {{Oxford University Press}},
  series       = {{American Journal of Clinical Pathology}},
  title        = {{Acute leukemias of ambiguous origin}},
  url          = {{http://dx.doi.org/10.1309/AJCPSTU55DRQEGTE}},
  doi          = {{10.1309/AJCPSTU55DRQEGTE}},
  volume       = {{144}},
  year         = {{2015}},
}