Monthly Cell Challenge #1 / 2025
Child with lymphoblasts on peripheral blood.
Description:
A 9-year-old female presented to the pediatric emergency room with fever, weakness, bone pain, enlarged lymph nodes, shortness of breath and loss of appetite.
CBC results:
| Test | Result | Units |
| WBC | 22.1 | x109/L |
| HGB | 14.1 | g/dL |
| MCV | 89.9 | fL |
| PLT | 256 | x109/L |
The patient also had an increased LDH value.
Blood smear analysis on CellaVision DC-1:
| WBC Differential | % | x109/L |
| Neutrophils | 46 | 10.2 |
| Eosinophils | 2.3 | 0.5 |
| Lymphocytes | 15.4 | 3.4 |
| Monocytes | 3.4 | 0.8 |
| Myelocytes | 1 | 0.2 |
| Metamyelocytes | 0.3 | 0.1 |
| Blasts | 31.5 | 7.0 |
CellaVision showed several lymphoblasts with high N:C ratio and with pleomorphic shape. The blast cells are heterogenous with an irregular shape and show clefts in the nucleus. The lab scientist added a comment describing the cells and sent the sample to a pathologist for review.
Other cell classes showed no morphological abnormalities.
Flow cytometry results: CD20+, dim CD33+, CD10+. Do, CD22+ CD15-, dim CD45+, CD34+, CD38+, CD81+, CD24+, CD79a+, TdT+
Diagnosis:
The patient was diagnosed with Pediatric B-Cell ALL. In the molecular testing, they also found a ETV6/RUNX1 mutation which correlates with a positive outcome in children.
Discussion:
B-cell acute lymphoblastic lymphoma (B-ALL) are found mainly in children and in young adults*.
Currently, a risk-directed therapy is the standard treatment for B-Cell ALL. Different factors are considered, for example: age, the initial white blood cell count, immunophenotypic and cytogenetic characteristics of the blast population, as well as the rapidity of response to early treatment. Standard treatment usually lasts 2–3 years of chemotherapy. For many patients a complete remission is achieved.
This case showed pleomorphic blast cells with irregular shapes in both cytoplasm and nucleus which can be mistaken for reactive lymphocytes. In the CellaVision Review Software, the side-by-side galleries will help distinguish the different cell classes.
Reference:
*Pathogenesis of pediatric B-cell acute lymphoblastic leukemia: Molecular pathways and disease treatments – Fang-Liang Huang, En-Chih Liao, Chia-Ling Li, Chung-Yang Yen, Sheng-Jie Yu.
Oncol Lett. 2020 May 4;20(1):448–454. doi: 10.3892/ol.2020.11583