Granular acute lymphoblastic leukemia in a 15-year-old boy

We report a case of a boy with acute lymphoblastic leukemia expressing gran ular inclusions in the cytoplasm of blastic cells, Granular lymphoblasts ha d mostly L2 morphology but azurophilic granules were also present in part o f the cells with L3 morphology, Immunophenotyping clearly indicated a lymph oid origin of the blasts and showed positivity of HLA-DR, CD10, CD19 and CD 24 markers. Cytogenetic analysis brought normal karyotype 46 XY, Molecular genetic analysis showed immunoglobulin heavy chain rearrangement (IgH R/R) and T-cell receptor gamma rearrangement pattern (TCR-gamma C/R), TCR-beta a nd TCR-delta did not show rearrangements. The course of the disease was fav ourable. The patient achieved initial complete remission within 4 weeks of protocolar treatment and the remission remains until now, 5 years from the diagnosis and three years after finishing the treatment.