Item: 1 of 4
QIO: 3418
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. 1
A 36-year-old woman complains t o her primary care physician that she has been severely fatigued for the past few mon
•2
come in to be evaluated sooner, because her children t old her th at it was normal to get really t ired as one ages. On phy
·3 she appears pale. Laboratory st udies show > 10% blast s in both her peripheral blood smear and her bone marrow. Her W
• 4 58,000/mm 3 . Results of her peripheral blood smear are shown in the image, which allows her physician to be fairly cert
diagnosis is ultimately confirmed when a characterist ic muta tion is found to be present in t he malignant cells, which can
medication.
Image cowtesy of T/1e Armed Forces Institute of Patf1ofogy ( AFIP)
Which of the following is t he most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Acute promyelocyti c leukemia
C. Burkitt's lymphoma
D. Chronic lymphocytic leukemia
8
Lode.
, Item: 1 of 4
QIO: 3418
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. 1
58,000/mm . Results of her periphera l blood smear are shown in the image, which allows her physician to be fairly cert
3
•2
diagnosis is ultimately confirmed when a characterist ic mut ation is found to be present in the malignant cells, which can
·3 medication.
• 4
Image courtesy of The Armed Forces Institute ofPathology(ARP)
Which of the following is t he most likely diagnosis?
A. Acute lymphoblast ic leukemia
B. Acute promyelocytic leukemia
C. Burkitt's lymphoma
D. Chronic lymphocytic leukemia
E. Hodgkin's lymphoma
8
Lode.
, Item: 1 of 4
QIO: 3418
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1 Th e correct an sw er is B. 69% ch ose this.
•2 This patient is suffering from acute promyelocytic leu kemia (APL), which is t he M3 subtype of acute
·3 myelogenous leukemia (AML} . A faggot cell can be seen in t he peripheral blood smear (within the t riang le)
• 4
cont aining numerous Auer rods, which is often pat hognomonic for APL. Auer rods are pink/reddish lines
formed from coalesced primary granules that are located wit hin promyelocytes. The presence of Auer rods
often helps distinguish between APL and other malignancies, alt hough Auer rods can be present in several
forms of AML and are not limited to j ust APL. However, t he presence of a faggot cell makes it much more
likely to be a diagnosis of APL rather than ot her subtypes in which single Auer rods are more commonly
seen. APL is unique in that it is very responsive to all-trans retinoic acid therapy. However, one must be
cautious during treatment because any treatm ent of the M3 form of AML can release Auer rods, leading to
disseminated intravascular coagulation. I n over 95% of cases of APL, a translocation event has occured
between the retinoic acid receptor gene on chromosome 17 and the promyelocytic leukemia gene on
chromosome 15, designated t(15;17)(q 22;q 12) .
Pro,..veloevbc leukf'l protem 0\.semmated intravascular coagulation Acute myefoid leukema Acute promteloc.ytlc leuke.. a Gene Rebno•c acid receptor
Leukemta Blood film Auer rod Rebno1c acid Azurophilic granule Chromosome 15 (human) Chromosorrte 17 (human) Malignancy Chromosome Cancer
I mage cou
Forces I ns
(AFIP)
A is n ot correct. 12°/o ch ose this .
Auer rods are not seen in acut e lymphoblast ic leukemia (ALL), because Au er rods are rest rict ed to cells of
t he myeloid lineage. ALL is the most common malignancy of children, and a peripheral blood smea r would
demonstrate lym phoblast s, as shown in t his image. The nuclear-to-cytoplasmic rat io is also likely t o be
grea ter in ALL cells because of t he presence of t hese lymphocytic precursors.
Acute lymphoblastic leukemia Leukemta Blood film Cancer Lymphoblast Malignancy Myeloid
8
Lode.
QIO: 3418
- ,•
~
Mark -<J
P~v•ous
[:::>
N@xt Labl
"'I
lues
~ ·
No tes
~
Calculato r
. 1
A 36-year-old woman complains t o her primary care physician that she has been severely fatigued for the past few mon
•2
come in to be evaluated sooner, because her children t old her th at it was normal to get really t ired as one ages. On phy
·3 she appears pale. Laboratory st udies show > 10% blast s in both her peripheral blood smear and her bone marrow. Her W
• 4 58,000/mm 3 . Results of her peripheral blood smear are shown in the image, which allows her physician to be fairly cert
diagnosis is ultimately confirmed when a characterist ic muta tion is found to be present in t he malignant cells, which can
medication.
Image cowtesy of T/1e Armed Forces Institute of Patf1ofogy ( AFIP)
Which of the following is t he most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Acute promyelocyti c leukemia
C. Burkitt's lymphoma
D. Chronic lymphocytic leukemia
8
Lode.
, Item: 1 of 4
QIO: 3418
- ,•
~
Mark -<J
P~v•ous
[:::>
N@xt Labl
"'I
lues
~
Notes
· ~
Calculator
• II""• 1.'"' .11 IT It.. tn I" t • II .. I"' I "' • I Ill ... • .. II"' t" - ...
. 1
58,000/mm . Results of her periphera l blood smear are shown in the image, which allows her physician to be fairly cert
3
•2
diagnosis is ultimately confirmed when a characterist ic mut ation is found to be present in the malignant cells, which can
·3 medication.
• 4
Image courtesy of The Armed Forces Institute ofPathology(ARP)
Which of the following is t he most likely diagnosis?
A. Acute lymphoblast ic leukemia
B. Acute promyelocytic leukemia
C. Burkitt's lymphoma
D. Chronic lymphocytic leukemia
E. Hodgkin's lymphoma
8
Lode.
, Item: 1 of 4
QIO: 3418
- ,•
~
Mark -<J
P~v•ous
[:::>
N@xt Labl
"'I
lues
~ ·
No tes
~
Calculato r
1 Th e correct an sw er is B. 69% ch ose this.
•2 This patient is suffering from acute promyelocytic leu kemia (APL), which is t he M3 subtype of acute
·3 myelogenous leukemia (AML} . A faggot cell can be seen in t he peripheral blood smear (within the t riang le)
• 4
cont aining numerous Auer rods, which is often pat hognomonic for APL. Auer rods are pink/reddish lines
formed from coalesced primary granules that are located wit hin promyelocytes. The presence of Auer rods
often helps distinguish between APL and other malignancies, alt hough Auer rods can be present in several
forms of AML and are not limited to j ust APL. However, t he presence of a faggot cell makes it much more
likely to be a diagnosis of APL rather than ot her subtypes in which single Auer rods are more commonly
seen. APL is unique in that it is very responsive to all-trans retinoic acid therapy. However, one must be
cautious during treatment because any treatm ent of the M3 form of AML can release Auer rods, leading to
disseminated intravascular coagulation. I n over 95% of cases of APL, a translocation event has occured
between the retinoic acid receptor gene on chromosome 17 and the promyelocytic leukemia gene on
chromosome 15, designated t(15;17)(q 22;q 12) .
Pro,..veloevbc leukf'l protem 0\.semmated intravascular coagulation Acute myefoid leukema Acute promteloc.ytlc leuke.. a Gene Rebno•c acid receptor
Leukemta Blood film Auer rod Rebno1c acid Azurophilic granule Chromosome 15 (human) Chromosorrte 17 (human) Malignancy Chromosome Cancer
I mage cou
Forces I ns
(AFIP)
A is n ot correct. 12°/o ch ose this .
Auer rods are not seen in acut e lymphoblast ic leukemia (ALL), because Au er rods are rest rict ed to cells of
t he myeloid lineage. ALL is the most common malignancy of children, and a peripheral blood smea r would
demonstrate lym phoblast s, as shown in t his image. The nuclear-to-cytoplasmic rat io is also likely t o be
grea ter in ALL cells because of t he presence of t hese lymphocytic precursors.
Acute lymphoblastic leukemia Leukemta Blood film Cancer Lymphoblast Malignancy Myeloid
8
Lode.
