EVALUATION OF BIPHENOTYPIC ACUTE LEUKEMIA WITH GENERALIZED LYMPHADENOPATHY: A CASE REPORT

It’s a rare case of acute biphenotypic leukemia which initially presented in an elderly lady with generalized lymphadenopathy and mild hepatosplenomegaly. Biopsy of cervical lymph node was done and diagnosed as Non-Hodgkin’s Lymphoma. Bone marrow smears showed 40% lymphoma cells, a few showing single large nucleolus. Peripheral blood smear showed moderate anemia and leucopenia but normal platelet count. On the basis of cervical biopsy and bone marrow findings, patient was given two cycles of Cyclophosphamide Hydroxydaurorubicin Oncoverin Prednisolone (CHOP) but she did not respond. In view of non responsiveness to CHOP, Immunophenotyping of bone marrow aspirate was done and result showed co-expression of both T-lymphoid and myeloid markers in 90% of atypical cells along with marker of immaturity (CD34) in 72% cells. Analysis showed expression of CyCD3 in 90% cells, CD33 in 95% cells and 60% cells were cytochemically positive for Myeloperoxidase (MPO); thus it was a case of Biphenotypic Acute Leukemia (T-ALL+AML) as per WHO criteria for diagnosis of BAL. So it was an initial presentation of BAL with generalized lymphadenopathy and aleukemic peripheral picture.