Hand mirror cell leukemia—immunologic and ultrastructural studies

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Abstract
Acute lymphoblastic leukemia (ALL) with hand mirror cell (HMC) variant was diagnosed in a 26-year-old black man in May 1978. Hemoglobin was 3.6 g/dl; the platelet count was 19.0 × 109/1; leukocyte count was 8.4 × 109/1 with 40% blasts, 66% of which had HMC appearance. Cytochemical studies, terminal deoxynucleotidyl transferase level, and immunologic marker studies indicated a non-T/non-B lymphoblastic origin of the leukemic population. Electron microscopic studies confirmed the hand mirror appearance. Mitochondria were more numerous in these cells compared with other lymphoid cells. Cytogenetic studies showed a 46XY karyotype. Our studies confirmed the previous studies reported by Stass, et al.22 of lymphoblastic origin of HMC leukemia. The patient responded to treatment with vincristine, prednisone and L-asparaginase and went into complete remission. It appears that this morphologic variant of ALL does exist and is not an artifact.