Light Scatter	CD45/14

CD34/38	DR/CD34	CD10/TdT

CD5/20	CD19/Kappa	CD19/Lambda

Other markers that where performed but were all negative include; myeloid markers (CD33, CD13, CD15 ), platelet marker (CD41), and T cell markers (CD3, CD7).

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Explaination and interpretation of Flow cytometry results
Explaination of other results seen (histology, hematology,etc) and facts about this patient's disease

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CBC
WBC Differential
Bone Marrow / Blood - characteristics/histology/hematology

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• The majority of cells in the bone marrow are of intermediate to large in size by forward angle light scatter and with low granularity (internal complexity) by 90 degree light scatter (see light scatter). This matches that seen by histology (see histology).

 
• The CD45/14 contour plot reveals that the cells within the set light scatter gates are split between low intensity CD45 expression and negative. This indicates that the cell population is most likely just starting to express CD45 and would be more mature than an early stem cell.  Plasmacytoid cells may exhibit this type of expression of CD45. There are no monocytes/promonocytes present (see CD45/14).

 
• The CD34/38 contour plot reveals that the majority of cells express only CD38 (on pre-B, plasma cells, thymocytes,& NK) and not CD34 (hemopoietic progenitor cell antigen). A early stem or pre-B cell is again excluded.   Plasmacytoid cell can not be excluded (based on flow cytometry) at this point (see CD34/38).

 
• The CD10/TdT contour plot demonstrates CD10 (Common acute lymphoblastic leukemia antigen - CALLA) positivity but not TdT (Terminal deoxynucleotidyl transferase) positivity. This suggests an immature B cell but not so early as to be TdT positive. Another posibilty would be a B cell lymphoma (Follicular cell lymphomas are often CD10 positive).  A plasmacytoid cell can now be excluded as they are CD10 negative. (see CD10/TdT).

 
• The CD5/20 contour plot shows that the cell in question is not postive for the T cell antigen CD5 or for the mature B cell antigen CD20. This again suggests an early B cell (see CD5/20).

 
• The CD19/kappa and CD19/lambda contour plots demonstrates CD19 (B cell antigen expressed on pre-B cells to mature B cells) positivity while not expressing surface immunoglobulin of either light chain.  Follicular cell lymphomas should be sIg positive. (see CD19/Kappa, CD19/lambda).

 
• All of these results when taken together suggest that this is a early-B acute lymphocytic leukemia (ALL).  This phenotype is typical of L3 (Burkitts-like) leukemia.  This is demonstrated in the ontogeny chart below where the L3 stage of maturation occurs between the pre-B and the virgin-B cell.  It should be stressed that the phenotype of most leukemias can vary to a degree (for example - a L3 may be sIg positive) and it is the overall phenotype which suggests the maturation stage.

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Bone marrow – characteristics/histology