3. leucemiile acute
TRANSCRIPT
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LEUCEMII ACUTE
Aspecte clinice, imagistice, citologice si histologice
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Leucemii acute (LA) aspecte clinice
• Petesii si echimoze pe fondul trombocitopeniei severe in doua cazuri de leucemie acuta mieloida (LAM).
• Trombocitopenia din leucemiile acute poate fi rezultatul atat al unei productii scazute, cat si a unui consum exagerat, in caz de coagulare intravasculara diseminata (CID).
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Leucemii acute (LA) aspecte clinice
• Infiltrat cutanat leucemic intr-un caz de leucemie acuta limfoblastica (LAL) cu celule T.
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Leucemii acute (LA) aspecte clinice
• Infiltrat leucemic cutanat (leucemide) in doua cazuri de leucemie acuta mieloida tip M5 (monoblastica).
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Leucemii acute (LA) aspecte clinice
• Hipertrofie gingivala la doua cazuri de leucemie acuta monoblastica (LAM tip M5).
• Hipertrofia gingivala este tipica pentru LAM cu componenta monocitara (M4 si M5).
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Leucemii acute (LA) aspecte clinice
• Leuziuni ulcerative la nivelul buzelor si limbii in context de stomatita candidozica la o pacienta cu LAM si neutropenie severa.
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Leucemii acute (LA) aspecte clinice
• Necroza epidermica la nivelul nasului in context de coagulare intravasculara diseminata (CID) la un pacient cu leucemie acuta mieloida tip M3 (promielocitara).
• CID severa la debut este tipica pentru LAM tip M3.
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Leucemii acute – aspecte radiologice
• Masa mediastinala, colectie pericardica si pleurala la un pacient cu leucemie acuta limfoblastica T.
• Masele ganglionare mediastinale sunt relativ frecvente in LAL tip T.
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Leucemii acute – aspecte radiologice
• RMN la o pacienta cu LAM relevand o tumora paravertebrala cu compresie spinala dorso-lombara si colectie pleurala.
• LAM care se prezinta ca tumori solide cu blasti mieloizi sunt eventualitati rare (1-5%) de debut a LAM, cunoscute sub numele de sarcoame granulocitice sau clorome.
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Leucemii acute – aspecte citologice
• Mieloblasti slab diferentiati intr-un caz de leucemie acuta mieloblastica tip M1.
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Leucemii acute – aspecte citologice
• Mieloblasti cu corpi Auer (bastonase rosii intra-citoplasmatice) intr-un caz de leucemie acuta mieloida tip M2.
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Leucemii acute – aspecte citologice
• Coloratia cu mieloperoxidaza (MPO) pozitiva intr-un caz de LAM tip M2 (zonele maronii in citoplasma celulelor blastice)
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Leucemii acute – aspecte citologice
• Promielocit cu multiplii corpi Auer (in manunchi), intr-un caz de leucemie acuta promielocitara (M3).
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Leucemii acute – aspecte citologice
• Monoblasti in sangele periferic al unui pacient cu leucemie acuta monoblastica (M5).
• Observati aspectul blastilor, asemanator monocitului cu nuclei lobulati, de forma neregulata.
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Leucemii acute – aspecte citologice
• Eritroblast cu morfologie anormala, cu vacuole, intr-un caz de eritroleucemie (LAM tip M6)
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Leucemii acute – aspecte citologice
• Maduva hipercelulara cu predominenta limfoblastilor intr-un caz de leucemie acuta limfoblastica (LAL).
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Leucemii acute – aspecte citologice
• Limfoblasti cu citoplasma vacuolata intr-un caz de LAL tip L3 (Burkitt-like).
• LAL tip Burkitt prezinta un fenotip B “matur” (expresie puternica a CD20, expresie slaba a CD10). Se asociaza cu prognostic sever.
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Leucemii acute – aspecte histopatologice
• Infiltrat medular masiv blastic intr-un caz de leucemie acuta (coloratie cu hematoxilina-eozina)
• Pozitivitatea puternica la marcarea cu anticorpi pentru CD10 stabileste diagnosticul de leucemie acuta limfoblastica comuna.
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Leucemii acute – aspecte histopatologice
• Infiltratie blastica masiva intr-un caz de leucemie acuta (coloratie hematoxilina-eozina).
• Pozitivitatea la mieloperoxidaza (MPO) stabileste diagnosticul de leucemie acuta mieloblastica.