Table 874. Morphologic Variants of AML Variant Cytologic Features Acute myeloblastic leukemia (M0, M1, M2) 1.

Myeloblasts are usually large; nuclear cytoplasmic ratio 1:1. Cytoplasm usually contains granules and occasionally Auer bodies. Nucleus shows fine reticular pattern and distinct nucleoli. 2. Blast cells are sudanophilic. They are positive for myeloperoxidase and chloroacetate esterase, negative for nonspecific esterase, and negative or diffusely positive for PAS (no clumps or blocks). 3. Electron microscopy shows primary cytoplasmic granules.

Special Clinical Features 1. Most common in adults, and most frequent variety in infants.

Special Laboratory Features 1. Chromosomes +8, 5, 7, common.

2. Three morphologiccytochemical types (M0, M1, M2)

2. M0 type blast cells positive with antibody to myeloperoxidase and antiCD34 and CD13 or CD33 coexpression. AML1 mutations in 25%.

Acute promyelocytic leukemia (M3, M3v)

1. Leukemic cells resemble romyelocytes. They have large atypical primary granules and a kidneyshaped nucleus. Branched or adherent Auer rods are common. 2. Peroxidase stain intensely positive. 3. A variant has microgranules (M3v), otherwise the same course and prognosis. 1. Both myeloblastic and monoblastic leukemic cells in blood and marrow. 2. Peroxidase-, Sudan-, chloroacetate esterase-, and nonspecific esterase-positive cells. 3. M4Eo variant has marrow eosinophilia. 1. Leukemia cells are large; nuclear cytoplasmic ratio lower than myeloblast. Cytoplasm contains fine granules. Auer rods are rare. Nucleus is convoluted and may contain large nucleoli. 2. Nonspecific esterasepositive inhibited by NaF;

1. Usually in adults.

3. M1 expresses CD13 and CD33. Positive for myeloperoxidase by cytochemistry. 4. (M2) AML with maturation often associated with t(8;21) karyotype. 1. Cell contains t(15;17) or other translocation involving chromosome 17 (RARgene).

2. Hypofibrinogenemia and hemorrhage common. 3. Leukemic cells mature in response to all-transretinoic acid. 1. Similar to myeloblastic leukemia but with more frequent extramedullary disease. 2. Mildly elevated serum and urine lysozyme.

2. Cells are HLA-DR negative.

Acute myelomonocytic leukemia (M4, M4Eo)

1. Eosinophilic variant has inversion or translocation of chromosome16.

Acute monocytic leukemia (M5)

1. Seen in children or young adults.

1. t(4;11) common in infants.

2. Gum, CNS, lymph node, and extramedullary

2. Rearrangement of q11;q23 very frequent.

Sudan-, peroxidase-, and chloroacetate esterasenegative. PAS occurs in granules, blocks.

infiltrations are common.

Acute erythroleukemia (M6)

1. Abnormal erythroblasts are in abundance initially in marrow and often in blood. Later the morphologic findings may be indistinguishable from those of AML.

3. DIC occurs. 4. Plasma and urine lysozyme elevated. 5. Hyperleukocytosis common. 1. Pancytopenia common at diagnosis.

Acute megakaryocytic leukemia (M7)

1. Small blasts with pale agranular cytoplasm and cytoplasmic blebs. May mimic lymphoblasts of medium to larger size.

1. Usually presents with pancytopenia.

2. Markedly elevated serum lactic dehydrogenase levels. 3. Marrow aspirates are usually "dry taps" because of the invariable presence of myelofibrosis. 4. Common phenotype in the AML of Down syndrome.

1. Cells reactive with antihemogloblin antibody. Erythroblasts usually are strongly PAS and CD71positive, express ABH blood group antigens, and react with antihemoglobin antibody. 2. Cells reactive with anti Rc-84 (antihuman erythroleukemia cell-line antigen). 1. Antigens of von Willebrand factor, and glycoprotein Ib (CD42), IIb/IIIa (CD41), IIIa (CD61) on blast cells. 2. Platelet peroxidase positive.

NOTE: Parentheses indicate FAB designation. NaF, sodium flouride; DIC, disseminated intravascular coagulation.