Large cells with abundant, intensely basophilic cytoplasm with prominent cytoplasmic vacuolization are identified on a peripheral smear. Multiple basophilic nucleoli are present. A starry sky appearance is seen with fields of basophilic leukemic blasts with benign macrophages that have ingested tumor cells. What leukemia should be suspected with this morphology?

Question

Quizplus · Accepted Answer

The presence of a starry sky appearance with fields of basophilic leukemic blasts and benign macrophages with ingested tumor cells is characteristic of acute lymphoblastic leukemia-Burkitt-type. The large cells with abundant, intensely basophilic cytoplasm and prominent cytoplasmic vacuolization with multiple basophilic nucleoli further support this diagnosis. Acute undifferentiated leukemia may also have a similar appearance, but the lack of lineage-specific markers would differentiate it from ALL-Burkitt-type. Acute leukemia with lineage heterogeneity and precursor T-cell leukemia would not typically present with a starry sky appearance.

Large Cells with Abundant, Intensely Basophilic Cytoplasm with Prominent Cytoplasmic