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Old 10-01-2011
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Blood Peroxidase, alpha-naphthyl butyrate esterase and PAS Negative!

A 59-year-old man was admitted because of generalized lymphadenopathy with fever and vomiting. His peripheral blood showed leukocytosis with a WBC of 93,500/μl, and the bone marrow picture revealed a predominance of blast cells. The blasts were negative for peroxidase, alpha-naphthyl butyrate esterase and PAS, and had the phenotype of CD 7, 13 and 33 positive. His initial status had been compromised by acute renal failure which necessitated hemodialysis.

Peroxidase, alpha-naphthyl butyrate esterase and PAS Negative!-blood-film.jpg
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What are the most likely diagnosis and prognosis of the disease?

A) CLL good
B) ALL poor
C) AML poor
D) CML poor
E) ALL good
F) AML good
G) CLL poor
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Default c) AML - poor

c) AML - poor
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sureeeeee its C AML with auer rods and as we know auer rods are present in m2 and m3 type so they have poor prognosis general rule the more auer rods the more poor prognosis
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C) AML poor
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c)AML n poor prognosis
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Quote:
Originally Posted by sumaira_azmat View Post
c)AML n poor prognosis
AML..... with poor prognosis " but still the question is why peroxidase -ve despite the presence of auer rods!!??.
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Correct Answer Answer

Quote:
Originally Posted by saddamehsan View Post
AML..... with poor prognosis " but still the question is why peroxidase -ve despite the presence of auer rods!!??.
This is AML with poor prognosis.

Diagnostic Clues guiding us for making a diagnosis:

1- Generalized lymphadenopathy

2- Leukocytosis

3- Predominance of Blast cells in bone marrow
=
---- Myeloid markers (CD13 and CD33 positive)
+
---- Often express B cell antigens such as CD7
as seen in this case

4- Cells are negative for Alpha-naphthyl acetate esterase (ANAE). (ANAE is a selective cytochemical enzymatic marker for monocytoid-oriented cells and macrophages. The detection of ANAE is used to identify these cell types in mixed lymphocyte preparations and hematopoietic stem cell differentiated populations.)
Key Point: AML M4/M5 are positive for nonspecific esterase (alpha naphthyl butyrate esterase)

5- Cells are negative for PAS. Key Point: AML M5/M6/M7 are positive for PAS.

6- Cell are negative for peroxidase.
Keypoint: Except AML M0 and M6, other AML types could be positive. In AML M0 LESS THAN 3% of cells are peroxidase positive. In AML M1, at least 3% of cells are positive for peroxidase.

So the diagnosis would be AML M0. However, the only thing that is not in consistent with the scenario is the presence of Auer rods in the picture becasue they are not usually present in AML M0.
In conclusion, I would say this is definitely a case of AML (maybe M0 or M1) and AML overally has poor prognosis.
For further information see the link below:
http://www.ncbi.nlm.nih.gov/pubmed/1602610
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