Granular acute lymhoblastic leukemia (ALL) is a recently described morphological variant of ALL in which pink or purple inclusions are seen in the cytoplasm on Wright stained smears. This can cause diagnostic difficulty since the inclusions may
be
confused with the primary granules seen in acute myeloblastic leukemia. The granules are normally more variable in size, often larger and more palely stained than myeloid primary granules.
We report a case of granular ALL(FAN L2) in 7 year old girl. She had severe anemia with hemoglobin of 6.8 gm/dl, a white cell count of 29.6×10E3/㎣ in peripheral blood. A bone marrow aspirate showed nearly 100% cellularity, and 97% of the
blasts.
The
60% and 71% blasts from blood and bone marrow, respectively, have azurophilic granules in cytoplasm.
Cytochemical studies by light microscopy revealed that the granules were negative for myeloperoxidase, sudan black B and specific esterase, and positive for non-specific esterase, PAS and acid phosphatase reaction. It suggested that the granules
were
lysosome. Most importantly, it should be more recognized as such and not confused with acute myeloid leukemia.
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