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Unique Pattern of Nuclear TdT Immunofluorescence Distinguishes Normal Precursor B Cells (Hematogones) From Lymphoblasts of Precursor B-Lymphoblastic Leukemia

Matthew T. Hurford MD, Arnold J. Altman MD, Joseph A. DiGiuseppe MD, PhD, Bradford J. Sherburne MD, William N. Rezuke MD
DOI: http://dx.doi.org/10.1309/ANERT51H38TUEC45 700-705 First published online: 1 May 2008

Abstract

Normal precursor B cells or hematogones share morphologic and immunophenotypic similarities with lymphoblasts of precursor B-lymphoblastic leukemia. The numbers are often increased and difficult to distinguish in many patients following chemotherapy for precursor B-lymphoblastic leukemia. The purpose of this study was to establish a unique method for differentiating hematogones from lymphoblasts by evaluating the immunofluorescence pattern of nuclear terminal deoxynucleotidyl transferase (TdT) staining in 29 cases of TdT+ acute leukemia and 20 cases with increased numbers of hematogones. All 29 cases of TdT+ acute leukemia demonstrated a finely granular pattern of TdT immunofluorescence that was uniformly distributed in the nucleus, whereas all 20 cases with increased hematogones demonstrated a coarsely granular or speckled pattern of TdT immunofluorescence, which often intensely aligns the nuclear membrane. The nuclear pattern of immunofluorescence using antibodies to TdT is an effective method for distinguishing hematogones from leukemic blasts.

Key Words:
  • Terminal deoxynucleotidyl transferase
  • TdT
  • Immunofluorescence
  • Normal precursor B cells
  • Hematogones
  • Precursor B-lymphoblastic leukemia