Leukemia: Macro preparation and Micro preparation in Pathology

Macro preparation and Micro preparation of Acute and chronic leukemia – Changes in Liver, Lung, and Spleen

Describe the following macro and micro preparations of Acute and chronic leukemia

  • Description of the macro preparation:
    1. Which body or part thereof is represented
    2. Surface condition
    3. Sectional view
    4. The condition of the cavities
    5. The prevalence of the process
    6. Conclusion
  • Descriptionofthemicropreparation
    1. Which organ tissue is represented
    2. Structural changes
    3. The prevalence of the process
    4. Conclusion


Macro and Micro Preparations of Liver in leukemia

Macro and Micro Preparations of Liver in leukemia
Liver in leukemia

Description of the macro preparation:

  • Liver
  • liver is usually nontender and firm with a smooth surface
  • enlarged and extensive lymphocytic infiltration in the portal tracts with functional impairment of the liver in late stages
  • Liver enlargement and elevation of liver enzymes related to specific involvement by the underlying disease are well-recognized features in these patients
  • B-CLL lymphocytes are positive for B-cell-associated antigens (CD19, CD20, CD21, and CD23) and CD5 and express extremely low levels of surface membrane immunoglobulins (IgM or both IgM and IgD)
  • Leukemia cells may build up in the liver and spleen, making them larger. This might be noticed as a fullness or swelling of the belly, or feeling full after eating only a small amount. The lower ribs usually cover these organs, but when the organs are enlarged the doctor can feel them.

Description of the micro preparation

  1. progressive accumulation of monoclonal lymphoid cells.
  2. replacement of normal bone marrow by leukemic cells, accumulation in peripheral blood and infiltration of organs.
  3. proliferation of young, immature elements in Acute leukemias and monoclonal proliferation of non-functional lymphoid and myeloid elements in Chronic leukemias
  4. rare blast cells (myeloblasts, promyelocytes) and numerous myelocytes, neutrophils, basophils, eosinophils, metamyelocytes, mature leukocytes. These tumor cells infiltrate and dilate the portal tracts, but especially the sinusoids.


Macro and Micro Preparations of Lungs in leukemia

Macro and Micro Preparations of Lungs in leukemia
Lungs in leukemia

Description of the macro preparation:

  • Lung
  • increased endothelial permeability, pulmonary edema and hemorrhage.
  • Thickening of interlobular septa and the peribronchovascular interstitium can be secondary to lymphatic spread of the tumor.
  • subsequent adhesion of blasts on the endothelial surface, increased endothelial permeability with pulmonary edema and hemorrhage, and finally interstitial invasion by leukemic cells.
  • found in about a quarter of patients in autopsy studies. lymphadenopathy is the most common manifestation of leukemia in the thorax, leukemia also may involve the lungs, pleura, pericardium, bones, and soft tissues.

Description of the micro preparation

  1. extravascular collections of leukemic cells in the lung parenchyma.
  2. Nodular thickening of the interlobular septa and peri-bronchovascular interstitium usually indicates tumor involvement or sarcoidosis.
  3. Thickening of interlobular septa increased endothelial permeability,


Macro and Micro Preparations of Spleen in leukemia

Macro and Micro Preparations of Spleen in leukemia
Spleen in leukemia


Description of the macro preparation:

  • Spleen
  • splenomegaly, which is an enlarged spleen
  • Multiple grey-white nodules ranging in size from 0.1 to 0.5 cm in dimension with a tan-yellow cut surface. Tiny focal lesions in the spleen.
  • enlarged lymph nodes, Tissues,
  • Neoplastic origins include chronic lymphocytic leukemia and lymphoma.
  • The spleen can become massively enlarged, particularly in indolent lymphomas, hairy cell leukaemia, chronic myelogenous leukaemia, polycythaemia vera and myelofibrosis. Splenic infarcts can also occur, especially with massive splenomegaly.

Description of the micro preparation

  1. Connective tissue disorders, white blood cells in the spongy tissue found inside large bones of the body (bone marrow), spleen, liver and blood.
  2. Hairy cell leukaemia, mild hepatosplenomegaly with multiple well-defined low attenuation, non-enhancing, <1 cm micronodules (white arrows) in the spleen due to leukaemic deposits
  3. red blood cell counts may be low or near normal and platelet counts are low (thrombocytopenia).
  4. Splenomegaly is the most consistent finding, with hepatomegaly reported in half and intra-abdominal lymphadenopathy in one-third of the cases of hairy cell leukaemia.