Abstract
This study reports findings from a retrospective, comprehensive review of 80 cases of adult AML in regard to cytomorphology, enzyme cytochemistry (EC), flow cytometric immunophenotyping (FCI), and chromosomal analysis. From this review, we conclude that diagnostically challenging cases can only be subtyped by combining the cytomorphology with EC, FCI, and subsequent cytogenetic results. This is particularly true in recognizing the hypogranular variant of AML,M3 (AML, M3m) and distinguishing it from other subtypes. Nonlineage expression of markers (CD1, CD2, CD4, CD5, CD7, and CD56) was nonspecific as to AML subtype. Of interest, CD2 coexpression in acute myelomonocytic leukemia with eosinophilia (M4‐Eo) was exclusively associated with inversion of chromosome 16 (inv 16) and was not observed in the other M4‐Eo's without inv16. We also recognized a previously undescribed M3m with CD56 coexpression, heightening awareness of this entity which needs to be distinguished from the unique subtype of CD56+ AML with otherwise similar immunophenotypic and morphologic characteristics. In addition, nonlineage expression of CD19 alone was exclusively associated with the cytogenetic finding of t (8;21) (q22; q22) and thus may represent a favorable prognostic indicator by FCI. J. Clin. Lab. Anal. 13:19–26, 1999. © 1999 Wiley‐Liss, Inc.
Keywords: AML, flow cytometry, cytogenetics, cytochemistry
REFERENCES
- 1. Goasguen JE, Bennett JM. Classifications of acute myeloid leukemia. Clinics in Laboratory Medicine 1990;10:661–681. Medline [PubMed] [Google Scholar]
- 2. Khalidi HS, Medeiros LJ, Chang KL, Brynes RK, Slovak ML, Arber DA. The immunophenotype of adult acute myeloid leukemia. High frequency oflymphoid antigen expression and comparison of immunophenotype, French‐American‐British classification, and karyotypic abnormalities. Am J Clin Pathol 1998;109:211–220. Medline [DOI] [PubMed] [Google Scholar]
- 3. Bennett JM, Catovsky D, Daniel M‐T, et al. Proposals for the classification of the acute leukaemias. French‐American‐British (FAB) Cooperative Group. Br J Haematol 1976;33:451–458. Medline [DOI] [PubMed] [Google Scholar]
- 4. Bennett JM, Catovsky D, Daniel M‐T, et al. Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French‐American‐British Cooperative Group. Ann Intern Med 1985;103:626–629. [DOI] [PubMed] [Google Scholar]
- 5. Bennett JM, Catovsky D, Daniel M‐T, et al. Proposal for the recognition of minimally differentiated acute myeloid leukaemia (AML‐M0). Br J Haematol 1991;78:325–329. Medline [DOI] [PubMed] [Google Scholar]
- 6. Bennett JM, Catovsky D, Daniel M‐T, et al. Criteria for the diagnosis of acute leukemia of megakaryocyte lineage (M7). A report in the French‐American‐British Cooperative Group. Ann Intern Med 1985;103(3):460–462.Medline [DOI] [PubMed] [Google Scholar]
- 7. The Second International Workshop on chromosomes in leukemia. Cancer Genet Cytogenet 1980;2:89–113. [PubMed] [Google Scholar]
- 8. Arthur DC, Bloomfield CD. Partial deletion of the long arm of chromosome 16 and bone marrow eosinophilia in acute nonlymphocytic leukemia: A new association. Blood 1983;61:994–998. Medline [PubMed] [Google Scholar]
- 9. Catovsky D, Matutes E. The classification of acute leukaemia. Leukemia 1992;6:1–6. [PubMed] [Google Scholar]
- 10. Campos L, Guyotat D, Archimbaud E, et al. Surface marker expression in adult acute myeloid leukemia: Correlation with initial characteristics, morphology and response to therapy. Br J Haematol 1989;72:161–166. Medline [DOI] [PubMed] [Google Scholar]
- 11. Sobol RE, Mick R, Royston I, et al. Clinical importance of myeloid antigen expression in adult acute lymphoblastic leukemia. N Engl J Med 1987;18:1111–1117. [DOI] [PubMed] [Google Scholar]
- 12. Bennett JM, Catovsky D, Daniel M‐T, et al. A variant form of hypergranular promyelocytic leukemia (letter). Ann Intern Med 1980;92(2 pt 1):261.Medline [DOI] [PubMed] [Google Scholar]
- 13. Drexler HG. Classification of acute myeloid leukemias: A comparison of FAB immunophenotyping. Leukemia 1987;1(10):697–705. Medline [PubMed] [Google Scholar]
- 14. Carey JL, Hanson, CA . Flow cytometric analysis of leukemia and lymphoma In Keren DF, Hanson CA, Hurtubise PE, editors. Flow cytometry and clinical diagnosis. Chicago: ASCP Press; 1994. 217 p. [Google Scholar]
- 15. Larson RS, McCurley TL. CD4 predicts nonlymphocytic lineage in adult leukemia: Insights from analysis of 125 cases using two‐color flow cytometry. Am J Clin Path 1995;104:204–211. Medline [DOI] [PubMed] [Google Scholar]
- 16. Brunning RD, McKenna RW, editors. Atlas of tumor pathology: Tumors of the bone marrow (third series, Fascicle 9). Armed Forces Institute of Pathology; 1994. 46 p. [Google Scholar]
- 17. Foucar K, editor. Bone marrow pathology. Chicago: ASCP Press; 1995. 198 p. [Google Scholar]
- 18. Miwa H, Nakase K, Kita K. Biological characteristics of CD7(+) acute leukemia. Leukemia and lymphoma 1996;21:239–244. Medline [PubMed] [Google Scholar]
- 19. Reuss‐Borst MA, Steinke B, Waler HD, Buhring JH, Muller CA. Phenotypic and clinical heterogeneity of CD56‐positive acute nonlymphoblastic leukemia. Ann Hematol 1992;64:78–82. Medline [DOI] [PubMed] [Google Scholar]
- 20. Mann KP, DeCastro CM, Liu J, Moore Jo, Bigner SH, Traweek ST. Neural cell adhesion molecule (CD56)‐positive acute myelogenous leukemia and myelodysplastic and myeloproliferative syndromes. Am J Clin Pathol 1997;107:653–660. Medline [DOI] [PubMed] [Google Scholar]
- 21. Scott AA, Head DR, Kopecky KJ, et al. HLA‐DR–, CD33+, CD56+, CD16– myeloid/natural killer cell acute leukemia: A previously unrecognized form of acute leukemia potentially misdiagnosed as French‐American‐British acute myeloid leukemia–M3. Blood 1994;84:244–255. Medline [PubMed] [Google Scholar]
- 22. Raife TJ, Lager DJ, Kemp JD, Dick FR. Expression of CD24(BA‐1) predicts monocytic lineage in acute myeloid leukemia. Am J Clin Pathol 1994;101:296–299. Medline [DOI] [PubMed] [Google Scholar]
- 23. Kita K, Nakase K, Miwa H, et al. Phenotypical characteristics of acute myelocytic leukemia associated with the t(8;21) (q22;q22) chromosomal abnormality: Frequent expression of immature B‐cell antigen CD19 together with stem cell antigen CD34. Blood 1992;80:470–477. Medline [PubMed] [Google Scholar]
- 24. Foucar K, editor. Bone marrow pathology. Chicago: ASCP Press; 1995. 204 p. [Google Scholar]
- 25. Brandt JT, Tisone JA, Bohman JE, Theil KS. Aberrant expression of CD19 as a marker of monocytic lineage in acute myelogenous leukemia. Am J Clin Pathol 1997;107:283–291. Medline [DOI] [PubMed] [Google Scholar]
- 26. Foucar K, editor. Bone marrow pathology. Chicago: ASCP Press; 1995, 195 p. [Google Scholar]
- 27. Larson RA, Williams SF, LeBeau MM, et al. Acute myelomonocytic leukemia with abnormal eosinophils and inv(16) or t(16;16) has a favorable prognosis. Blood 1986;68:1242–1249. Medline [PubMed] [Google Scholar]
- 28. Niwa‐Kawakita M, Miyoshi H, Gotoh O, et al. Gene mapping of the mouse homologue of the CBFA2T1 gene associated with human acute myeloid leukemia. Genomics 1995;29:755–759. Medline [DOI] [PubMed] [Google Scholar]
- 29. Tobal K, Johnson PR, Saunders MJ, Harrison CJ, Liu Yin JA. Detection of CBFB/MYH11 transcripts in patients with inversion and other abnormalities of chromsome 16 at presentation and remission. Br J Haematol 1995;91:104–108. Medline [DOI] [PubMed] [Google Scholar]
- 30. First International Workshop on Chromosomes in Leukaemia . Chromosomes in acute non‐lymphocytic leukaemia. Br J Haematol 1978;9:311–316. [DOI] [PubMed] [Google Scholar]
- 31. Van Den Berghe H, Louwagie A, Broeckaert‐VanOrshoven A, et al. Chromosome abnormalities in acute promyelocytic leukemia (APL). Cancer 1979;43:558–562. Medline [DOI] [PubMed] [Google Scholar]