Link of Video Abstract: https://www.youtube.com/watch?v=AC472eZBXII
Background: Most acute leukemias can be classified into myeloid or lymphoid strains based on the expression of several specific phenotypes. However, some cases of acute leukemia express both phenotypes (myeloid and lymphoid phenotypes). To establish the diagnosis of acute leukemia with co-expression of myeloid markers or mixed phenotype acute leukemia (MPAL), we need a system that can differentiate between the two, namely by using the scoring system from The European Group for the Immunological Characterization of Leukemias (EGIL) and The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues 2016.
Case Presentation: A 10-year-old boy was admitted to the hospital because of repeated nosebleeds for 3 weeks before entering the hospital. Patients also complain of decreased appetite, nausea, vomiting, and joint pain. On physical examination, anemic conjunctiva was found, and no abnormalities were found on other physical examinations. Hemoglobin examination: 8.2 g/dl, leukocytes 112.10×103/µl, platelets 10×103/µl. Examination of peripheral blood smear: acute lymphoblastic leukemia. Examination results of bone marrow aspiration acute lymphoblastic leukemia (ALL L1). Immunophenotype analysis found blast cells with positive expression for CD34, CD79a, CD10, HLA-DR, CD33 and CD13.
Conclusion: The diagnosis in this patient was B-ALL with myeloid marker co-expression based on the EGIL and WHO scoring systems.