Case Report

Korean J Lab Med 2007; 27(4): 253-256

Published online August 1, 2007

Copyright © Korean Society for Laboratory Medicine.

A Case of CD45-, CD19- Precursor B Cell Acute Lymphoblastic Leukemia with an Atypical Morphology

Heewon Moon, M.D.1, Jungwon Huh, M.D.1, Min-Sun Cho, M.D.2, Hyunsook Chi, M.D.3, and Wha Soon Chung, M.D.1

Departments of Laboratory Medicine1 and Pathology2, School of Medicine, Ewha Womans University, Seoul; Department of Laboratory Medicine3, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: 허 정 원
우 158-710 서울시 양천구 목동 911-1 이화여자대학교 의학전문대학원 진단검사의학교실
전화: 02-2650-5320, Fax : 02-2650-5091

Received: March 20, 2007; Revised: June 26, 2007; Accepted: June 26, 2007


The differential diagnosis of acute lymphoblastic leukemia (ALL) from other small round blue cell tumors in children is very important for proper treatment, but sometimes difficult. CD45 is expressed on almost all-human leukocytes and not expressed on other small round blue cell tumors. Moreover, CD19 is expressed on all stages of B lineage cells and loss of this antigen is very rare in precursor B-cell ALL. We report a case of ALL with atypical morphology and immunophenotype. A 6-yr-old girl presented with fever and weight loss. Many abnormal cells with variable sized, high nuclearcytoplasmic ratio and distinct nucleoli were counted 23% in bone marrow. The results of immunophenotyping were negative for CD45, CD19, CD10, CD20, CD3, CD5, CD7, CD56/16, CD13, and CD33 and positive for CD22, TdT, and CD34. The immunohistochemical staining of bone marrow biopsies was positive for CD79a, CD10, TdT and CD99. The cytogenetic study showed normal karyotype but amplification of MLL (myeloid/lymphoid or mixed lineage leukemia) gene was suggestive in the fluorescent in situ hybridization. The patient received the standard chemotherapy for acute lymphoblastic leukemia and reached complete remission.

Keywords: CD45, CD19, Acute Lymphoblastic Leukemia