Abstract
A 79-year-old woman, complaining of malaise and fever, was admitted to our hospital on January 11th, 1984, when pea-sized lymphadenopathies in axillary and inguinal region, ascites and hepatomegaly were noticed.
Hematological examination on admission showed a WBC of 36,200/mm8 with 89% blasts, and a nucleated cell count in the bone marrow of 74,000/mm8 with 84.6% blasts. The blasts were negative on peroxidase staining. ATLA (adult T-cell leukemia associated antigen) antibody was negative. TdT (terminal deoxynucleotidyl transferase) activity showed 1.9 U/108 cells. The concentration of serum immunoglobulin was normal. Chromosome examination of bone marrow cells showed an abnormal karyotype of 49, XX, +9, +18, -19, +mar1, +mar2. The examination of blast surface markers showed 8% E-rosette, 1% s-Ig, 84.1% B1, 73.2% OKIa1, 35.8% OKT10 and 14.1% J5. After VP (vincristine, prednisolone) therapy, the patient initially showed a decrease in the number of blasts. A month later, however, the blast number increased and the patient died.
The clinical and pathological diagnosis in this case was ALL (L2 type by FAB classification).
On autopsy, there was no cytoplasmic-IgM in the blasts.
ALL with surface markers of B cell (B1+) in an elderly patient is rarely found.
