Case Report

Granular Acute Lymphoblastic Leukemia in Adults: Report of a Case and Review of the Literature

Authors: James W. Fulcher, MD, Thomas J. Allred, MD, Anita Kulharya, PHD, K L. Satya-Prakash, PHD, Maree Seigler, HT, Doris Neibarger, MT, Fermina M. Mazzella, MD

Abstract

The diagnosis of granular acute lymphoblastic leukemia (ALL) can be problematic as the cytoplasmic granules found in many blast cells may mimic those seen in acute myelogenous leukemia (AML). This rare variant of B-cell ALL is more commonly diagnosed in children, but may occur in adults. We report a case of granular B-ALL in a 56-year-old female and review the literature.


Key Points


* Granular lymphoblastic leukemia is most commonly seen in children, but the diagnosis should be considered in adults as well.


* Cases of granular lymphoblastic leukemia in adults may look morphologically similar to acute myelogenous leukemia; thus, morphology alone may lead to misdiagnosis in these patients.


* There is great variation in patient age, in presentation blast count and in blast morphology in the reported cases, which highlights the importance of histochemical and immunophenotypic studies in these cases.


* We report the first double Philadelphia chromosome found in an adult with granular acute lymphoblastic leukemia (ALL). Philadelphia chromosome is an indicator of poor prognosis in childhood ALL, but its significance in granular adult ALL is as yet unknown.

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References

1. Rosen NR, DiFino S, Nelson DA, et al. Acute leukaemia with unusual cytoplasmic inclusions.Cancer 1979;43:2405–2409.
 
2. Yanagihara ET, Naeim F, Gale RP, et al. Acute lymphoblastic leukemia with giant intracytoplasmic inclusions. Am J Clin Pathol 1980;74:345–349.
 
3. Canta-Rajnoldi A, Inverizzi R, Biondi A, et al. Biological and clinical features of acute lymphoblastic leukemia with cytoplasmic granules or inclusions: description of eight cases. Br J Haematol1989;73:309–314.
 
4. Hay CR, Barnett D, James V, et al. Granular common acute lymphoblastic leukaemia in adults: a morphological study. Eur J Haematol 1987;39:299–305.
 
5. Fradera J, Velez-Garcia E, White JG. Acute lymphoblastic leukemia with unusual cytoplasmic granulation: a morphologic, cytochemical, and ultrastructural study. Blood 1986;68:406–411.
 
6. Schwarzinger I, Fodinger M, Scherrer R, et al. Hypergranular acutelymphoblastic leukemia (ALL): report of a case and review of the literature. Ann Hematol 1993;67:301–303.
 
7. Brunning RD, Matutes E, Borowitz M. Acute leukaemias of ambiguous lineage. In: Jaffe ES, Harris NL, Stein H, eds. Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France, IARC Press, 2001, p 106.
 
8. van der Velden VH, Szczepanski T, Wijkhuijs JM, et al. Age-related patterns of immunoglobulin and T-cell receptor gene rearrangements in precursor B-ALL: implications for detection of minimal residual disease. Leukaemia 2003;17:1834–1844.
 
9. Tsoi WC, Lai HD, Feng CS. T-acute lymphoblastic leukemia with cytoplasmic granules. Am J Hematol 1997;56:193–194.
 
10. Cerezo L, Shuster JJ, Pullen DJ, et al. Laboratory correlates and prognostic significance of granular acute lymphoblastic leukemia in children: a Pediatric Oncology Group study. Am J Clin Pathol1991;95:526–531.
 
11. Stein P, Peiper S, Butler D, et al. Granular acute lymphoblastic leukemia. Am J Clin Pathol1983;79:426–430.
 
12. Faderl S, Jeha S, Kantarjian HM. The biology and therapy of adult acute lymphoblastic leukemia.Cancer 2003;98:1337–1354.