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Acute leukemia with megakaryocytic differentiation: a study of 12 cases
identified immunocytochemically
MJ Huang, CY Li, WL Nichols, JH Young and JA Katzmann
Acute leukemia with megakaryocytic differentiation has been an uncommonly
recognized disorder. We used specific monoclonal and polyclonal antibody
reagents (HP1-1D antibody and anti-factor VIII antibody, respectively) and
an immunocytochemical staining technique to identify the megakaryocytic
nature of the leukemic cells of 12 patients who presented with acute
leukemia. The leukemic cells of our patients demonstrated the presence of
one or both of these platelet- and megakaryocyte-related antigens, but were
negative for all of the commonly employed cytochemical and
immunocytochemical staining reactions, except for diffuse acid phosphatase
activity and granular PAS positivity. Morphologically, the leukemic cells
varied in size from 10 to 40 microns in diameter, frequently had
cytoplasmic budding, and contained occasional vacuoles and/or
peroxidase-negative azurophilic granules. Five patients presented with
syndromes of acute myelofibrosis, and seven patients had otherwise
unclassifiable acute leukemias, including three patients who had secondary
leukemias. Diffuse reticulin myelofibrosis was present in all cases in
which it was sought. Chromosomal abnormalities of leukemic cells were found
in five cases. Two patients had deficiencies of plasma coagulation factor
V. Study of one patient revealed significant platelet dysfunction. When
cytoreductive chemotherapy of leukemia was attempted, the observed response
was generally poor, with the exceptions of one patient who has remained in
complete remission following treatment with etoposide (VP- 16) and a second
patient who attained remission following bone marrow transplantation. These
cases of acute megakaryoblastic leukemia represented from 3.6% to 9.3% of
all acute leukemia cases diagnosed concomitantly in our institution. Acute
leukemia with megakaryocytic differentiation may occur more frequently than
previously recognized, may present with differing syndromic features, and
can be identified by the use of specific antibody reagents and relatively
simple immunocytochemical techniques.
Volume 64,
Issue 2,
pp. 427-439,
08/01/1984
Copyright © 1984 by The American Society of Hematology
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