Microscopic Description -- Dyspnea and Leukocytosis
76% lymphocytes, 24% blasts
Blasts in the peripheral blood are large with a high nuclear:cytoplasmic ratio, dispersed chromatin, rounded and irregular nuclear contours, prominent nucleoli and basophilic cytoplasm with occasional vacuoles. Cytoplasmic granules (Image 01) were also present.
Lymphocytes (Images 01 and 02) are mostly small with irregular nuclear contours, scant cytoplasm and occasionally indistinct nucleoli. Aspirate smears showed numerous lymphocytes and blasts (Image 03) similar to those described in the peripheral blood. The biopsy is hypercellular (100% cellular) with extensive replacement (Images 04, 05 and 06)
by an infiltrate of the blasts described in the peripheral blood. In addition, there are a few small clusters of small lymphoid cells (Image 07). Hematopoietic elements are markedly decreased. Cytochemical stains demonstrated many of the blasts to be strongly positive with non-specific esterase (inhibited by fluoride), and weak to strong positivity with peroxidase (Image 08). Rare blasts were positive with chloroacetate esterase (Image 09).