leukemia - CGL?

Re: leukemia - CGL?

Richard Fox — Fri, 13 Jul 2012 11:58:32 GMT

Thanks for the images David - those look like large blasts to me - Although no definitive metamyelocytes the degree of differentiation can vary widely IIRC with Granulocytic Leukaemia. Some of the cells in your original images appear somewhat myeloid with the lobular to indented nuclei. Given the supportive information of no pyrexia etc I would also suggest this is/was most probably CML.

Re: leukemia - CGL?

ilanit — Wed, 11 Jul 2012 15:26:56 GMT

Thanks for the pictures.

My colleague put the cat to sleep yesterday on owners request, so cannot take more samples (from spleen).

Re: leukemia - CGL?

David Mills — Tue, 10 Jul 2012 10:43:49 GMT

Here are some pictures, apologies for format

Re: leukemia - CGL?

David Mills — Tue, 10 Jul 2012 10:28:04 GMT

This is leukaemia. In our experience, often leukocystosis will be the only abnormality on haem and 65 is high - anaemias are variable. Infection would be unlikely in this case. If your client will allow a splenic FNA feel free to post that, stained, as it may give more info. Immunohistochemistry of flow cytometry is required to differentiate origin.

Re: leukemia - CGL?

ilanit — Sat, 07 Jul 2012 16:18:02 GMT

Thanks for your reply!

Cat's temp yesterday was 39.3. Today 38.4. He's quite bright. Apart from being skinny and mildly dehydrated yesterday exam is unremarkable. He seemed to me the typical hyperthyroid cat. Htc was normal (but cat was dehydrated so there might be a mild anemia), platelets bit low, but seem adequate on smear. Biochem (very basic profile): only increased AlkPhos and TP. Cannot remember how much, but not dramatic.

On ultrasound: structure of kidneys abnormal (kidney values normal) and hypoechoic spleen. Cat generally bright today. No source of infection found. No thorax x-ray performed, but normal breathing sounds and with ultrasound no fluid noted.

Yes 65.000/microliter. I understood that > 50.000/microliter is a leukemoid reaction and carries a poor prognosis. There seems to be no obvious serious infection to explain this response. Also the demeanour of the cat does not fit in this picture, so was thinking paraneoplastic or chronic leukemia a fair possibility.

Unfortunately owner does not want to do more tests and just wants to see how he responds to antibiotics. Would have liked to check for FeLV/FIV.

Will probably never find out :(

Will try to take a better smear later though to see if I'll get a nicer picture (yes from EDTA sample - but would have been there only hour most)

Re: leukemia - CGL?

Richard Fox — Sat, 07 Jul 2012 10:25:44 GMT

HI All

Although I do a lot of soft tissue/fluid cytology I am not a haematologist and differentiating leukaemia is quite a specialised field I am afraid. Obviously there is a lot of artefact here (crenated RBC's) also I wonder if this sample has been stored in EDTA? This will give you nuclear artefact in in my experience cell swelling making thecells appear much larger. I would be reluctant to dx a chronic myeloid leukaemia - I see no obvious myelocytes (with granules) although the mononuclear cells could be metamyelocytes - I would not rule out CML though - The 65 you quote - is that 65x10 9/L? while this is high its not astronomical.

Also with leukaemia there are other haem abnormalities like pancytopenia/non-regen anemias? are there other signs - any evidence of a septic focus/inflam to rule that out like pyrexia. heat, swelling, discharges?

Re: leukemia - CGL?

Rajat — Fri, 06 Jul 2012 21:04:27 GMT

To me this seems like a leukaemia. The cells are far too large frequent and I see anisokaryosis and multiple nucleoli

I don't think this is consistent with infection.

Will ask a pathologist to comment too so you have an educated opinion