症　　　例

芽球に顆粒を有する
急性リンパ性白血病(ALL)の 2 例

森　田　志　保*1　西　郷　勝　康*2　小　阪　嘉　之*3
佐　野　公　彦*4　巽　　　英　二*5　井　本　しおん*6
下　村　大　樹*7　吉　田　四男美*8　鎮　西　忠　信*9
　　　　　　　　　　　　　　　　　　　　　　
Two Cases of Acute Lymphoblastic Leukemia with Cytoplasmic Granules

Shiho MORITA, MD*1, Katsuyasu SAIGO, MD*2, Yoshiyuki KOSAKA, MD*3,
Kimihiko SANO, MD*4, Eiji TATSUMI, MD*5, Shion IMOTO, MD*6,
Daiki SHIMOMURA*7, Shiomi YOSHIDA*8 and Tadanobu CHINZEI*9

The presence of cytoplasmic granules in blastoid cells of patients with acute leukemia is generally accepted as a useful morphological marker for differentiation of myeloid leukemia from lymphoblastic leukemia. We diagnosed two cases of acute lymphoblastic leukemia(ALL) with cytoplasmic granulation. Surface marker analysis of leukemic cells revealed they were positive for CD10, 19, 20, 33, 34 and HLA-DR. Immunoglobulin gene rearrangement was detected by means of Southern hybridization with an Ig-JH probe for both patients. On the basis of these findings, the patients were diagnosed as having B-precursor ALL. Electron microscopic observation showed no myeloperoxidase activity, so that the granules were considered to be related to autophagolysosomes. This experience demonstrates that the recognition of the presence of granular ALL is necessary for making an accurate differential diagnosis of acute leukemias.
[Rinsho Byori 50 : 625〜629, 2002]

*2Blood Transfusion Division, Kobe University Hospital, Kobe 650-0017

【Key Words】ALL(急性リンパ性白血病)，granules(顆粒)，lysosome(ライソソーム)

受付2001年11月8日・受理2002年2月8日
*1,9加古川市民病院内科(〒675-8611 加古川市米田町平津384-1)
*2神戸大学病院輸血部，*3,4同　医学部小児科，*5同　医学部国際交流センター(〒650-0017 神戸市中央区楠町7)
*6兵庫県赤十字血液センター(〒651-0062 神戸市中央区坂口通2-1-1)
*7,8天理よろづ相談所医学研究所(〒632-8552 天理市三島町200)

E-mail :saigo@med.kobe-u.ac.jp