In a patient with acute leukemia, immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, CD13+ve. He may probably have-
Answer is A (Biphenotypic leukemia) Biphenotypic leukemias are leukemias that express features of more than one lineage. The patient in question has a rare leukemia that expresses both, myeloid antigens (CD 33 and CD 13) and Lymphoid antigens of B cell lineage (CD 10 and CD 19) and hence can be described as a Biphenotypic leukemia. Biphenotypic Leukemias Biphenotypic Leukemias are rare acute leukemias that express both myeloid and lymphoid associated antigens to a degree that no single lineage can be assigned. Scoring systems have been proposed to more precisely defines biphenotypic leukemias and to distinguish these cases from 'ALL with myeloid antigen expression' or 'AML with lymphoid antigen expression' Scoring System for Biphenotypic Acute Leukemia Points B Lineage T Lineage Myeloid Lineage 2 CD79a CD3 (m/cyt) Anti-MPO (monoclonal) Cyt IgM Anti-TCR a/B MPO cytochemistry Cyt CD22 Anti-TCR y/S I CDI9 CD2 CDII7 CD10 CD5 CD 13 CD20 CD8 CD33 CDIO CD65s Anti-MPO (polyclonal) 0.5 TdT TdT CD I4 CD24 CD7 CD 15 CD 1 CD64 M, membrane; cyt, cytoplasm; MPO, myeloperoxidase A diagnosis of biphenotypic acute leukemia requires a score of more than 2 points for the myeloid and one of the lymphoid lineages. The patient in question scores two points for myeloid lineage and two points for lymphoid B cell lineage and hence can be classified as a Biphenotypic Leukemia
Biphenotypic leukemia
ALL
AML-M2
AML-Mo