A four year old boy was admitted with a history of abdominal pain and fever for two months, maculopapular rash for ten days, and dry cough, dyspnea and wheezing for three days. On examination, liver and spleen were enlarged 4 cm and 3 cm respectively below the costal margins. His hemoglobin was 10.0 g/dl, platelet count 37 x 109/L and total leukocyte count 70 x 109/L, which included 80% eosinophils. Bone marrow examination revealed a cellular marrow comprising 45% blasts and 34% eosinophils and eosinophilic precursors. The blasts stained negative for myeloperoxidase and nonspecific esterase and were positive for CD19, CDIO, CD22 and CD20. Which one of the following statements in not true about this disease?
A four year old boy was admitted with a history of abdominal pain and fever for two months, maculopapular rash for ten days, and dry cough, dyspnea and wheezing for three days. On examination, liver and spleen were enlarged 4 cm and 3 cm respectively below the costal margins. His hemoglobin was 10.0 g/dl, platelet count 37 x 109/L and total leukocyte count 70 x 109/L, which included 80% eosinophils. Bone marrow examination revealed a cellular marrow comprising 45% blasts and 34% eosinophils and eosinophilic precursors. The blasts stained negative for myeloperoxidase and nonspecific esterase and were positive for CD19, CDIO, CD22 and CD20. Which one of the following statements in not true about this disease?
💡 Explanation
**Core Concept**
The patient's presentation of abdominal pain, fever, maculopapular rash, dry cough, dyspnea, and wheezing, along with laboratory findings of eosinophilia, anemia, thrombocytopenia, and a cellular bone marrow with blasts, is suggestive of a hematological malignancy. The presence of CD19, CD10, CD22, and CD20 positivity on the blasts points towards a specific type of leukemia.
**Why the Correct Answer is Right**
The patient's clinical and laboratory findings are consistent with Acute Lymphoblastic Leukemia (ALL) with eosinophilia. The presence of eosinophilia in ALL is often associated with the presence of eosinophilic precursors in the bone marrow. The blasts in this case stain negative for myeloperoxidase and nonspecific esterase, which rules out acute myeloid leukemia (AML). The CD19, CD10, CD22, and CD20 positivity on the blasts confirms the diagnosis of B-cell ALL.
**Why Each Wrong Option is Incorrect**
**Option A:** This statement is incorrect because it is not true that ALL is typically associated with eosinophilia. While eosinophilia can be seen in some cases of ALL, it is more commonly associated with other conditions such as eosinophilic leukemia or parasitic infections.
**Option B:** This statement is incorrect because it is not true that the blasts in ALL are typically negative for CD10. CD10 is a common marker expressed on the surface of B-cell ALL blasts.
**Option C:** This statement is incorrect because it is not true that the bone marrow in ALL is typically hypocellular. The bone marrow in ALL is often cellular, with a high percentage of blasts.
**Option D:** This statement is incorrect because it is not true that the diagnosis of ALL is typically made based on the absence of myeloperoxidase and nonspecific esterase staining. While these stains can be helpful in ruling out AML, they are not diagnostic of ALL.
**Clinical Pearl / High-Yield Fact**
Eosinophilia in ALL can be associated with a worse prognosis and may require specific treatment approaches. It is essential to recognize the presence of eosinophilia in patients with ALL and to consider it as a component of their overall treatment plan.
**Correct Answer:** A.
✓ Correct Answer: D. Inv (16) is often detected in the blasts and the eosinophils.
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