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Case Reports in Pathology
Volume 2013, Article ID 679892, 4 pages
Case Report

Precursor B-Cell Acute Lymphoblastic Leukemia/Lymphoma with L3 Morphology, Philadelphia Chromosome, MYC Gene Translocation, and Coexpression of TdT and Surface Light Chains: A Case Report

1Mount Sinai Medical Center, A.M. Rywlin, Department of Pathology and Laboratory Medicine, 4300 Alton Road, Suite 2200, Miami Beach, FL 33140, USA
2Neogenomics Laboratories, 12701 Commonwealth Drive, Fort Myers, FL 33913, USA

Received 16 January 2013; Accepted 1 February 2013

Academic Editors: T. Hasebe, H. Kuwabara, A. Pich, A. Rajput, P. Tosi, and A. N. Walker

Copyright © 2013 Alicia C. Hirzel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Acute lymphoblastic leukemia is predominantly found in children. It is a neoplasm of precursor cells or lymphoblasts committed to either a B- or T-cell lineage. The immature cells in B-acute lymphoblastic leukemia/lymphoma can be small or medium sized with scant or moderate cytoplasm and typically express B-cell markers such as CD19, cytoplasmic CD79a, and TdT without surface light chains. These markers, along with cytogenetic studies, are vital to the diagnosis, classification, and treatment of these neoplasms. We present an unusual case of a precursor B-cell ALL, in an 82-year-old woman, who presented with pancytopenia and widespread lymphadenopathy. The cells show L3 morphology (Burkitt-like lymphoma) with coexpression of TdT and surface light chains in addition to an MYC gene translocation and Philadelphia chromosome.