Blood Res.  2021 Dec;56(4):335-339. 10.5045/br.2021.2020231.

A look inside the body of a BCR-ABL1−like acute lymphoblastic leukemia patient: the first case report highlighting the continued relevance of autopsy practice

• Rastogi P
• Bhatia P
• Sreedharanunni S
• Lad D

• KMID: 2524095
• DOI: http://doi.org/10.5045/br.2021.2020231

Figure

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  Fig. 1 Spectrum of the pathological changes seen for the basic underlying disease during autopsy. Touch imprint smears made from postmortem bone marrow biopsy showing blasts with coarse chromatin and scanty cytoplasm (A, ×1,000). Section of bone marrow biopsy (B, ×400) showing dispersed blasts, marrow edema, congested sinusoids, and hemophagocytosis (yellow arrow). Immunohistochemistry (IHC) for CD20, TdT, and CD68, respectively, highlighting blasts and increased histiocyte count (C–E, ×400). (F) Gross photograph of the organ complex comprising a slice of the liver, C-loop of the duodenum, pancreas, and a slice of the spleen (mildly enlarged). White of spleen is preserved (G, ×200) but shows scattered TdT positive cells on IHC (H, ×400). (I) The red pulp of spleen shows extramedullary hematopoiesis (arrow indicates a megakaryocyte, ×400). Portal tracts are mildly expanded due to blast infiltration (J, ×200). (K) Pancreatic acinar tissue shows leukemic infiltrates (yellow arrow, ×200). (L) Pericardium and endocardium (M) showing leukemic infiltrates (yellow arrows, ×200).

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  Fig. 2 Renal pathology of the case. Gross photograph of both the kidneys showing unremarkable morphology (A). An image (×40) of renal tissue showing the extent of leukemic infiltrates, which are highlighted by hematoxylin (blue areas, B). There are peri-glomerular leukemic infiltrates (C, ×400). Leukemic infiltrates are also seen in renal interstitium (D, ×400). Immunohistochemistry for CD20 and TdT, highlighting the blasts. Bottom row depicts the qRT-PCR results performed using leukemic infiltrates in renal tissue for CRLF2 (gene of interest) and SDH (internal control), and the melting curve analysis demonstrates that CRLF2 is expressed approximately 280 times more than that in the control (E, F).

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  Fig. 3 Spectrum of pathologies that led to the death of patient. Gross photograph of a slice of the right lung showing a hemorrhagic area (yellow circle) near the hilum (A). A large thrombus is seen in main branch of pulmonary artery (yellow arrow) with surrounding areas of hemorrhagic infarct (B, ×40). One of the pulmonary vessels showing fungal hyphae that are broad, aseptate, and with right-angled branching, conforming to the morphology of the Rhizopus species (C, ×400). Another focus in pulmonary parenchyma showing fungal hyphae which is straight, septate, and with no inflammatory response, conforming to the morphology of Trichosporon species (D). Gross photographs of stomach showing diffusely ulcerated mucosa and a thickened wall (5 mm) (E, F). Microscopy of stomach showing ulcerated mucosa and markedly edematous submucosa (G,×100) with many thrombosed vessels (H, ×400). Gross image of the jejunum showing transversely oriented linear ulcers (I). (J) Microscopy of the jejunal ulcer depicting their superficial location limited to the submucosa (yellow arrow, ×40). (K) The ulcer base showing fibrin thrombi in the vascular lumen (yellow arrow, ×200). (L) Some other vessels in submucosa showing numerous fungal profiles in lumen (Gomori Methanamine silver stain, ×400).

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