Cuplike nuclei (CLN) (nuclei with prominent invagination) are recognized as a distinctive morphologic finding in the blasts of acute myeloid leukemia (AML).1-6  They are seen in ∼20% of all AML cases2,4,5  and are associated with normal karyotype, absence of CD34 and HLA-DR, and mutation of fms-related tyrosine kinase 3 (FLT3) and/or nucleophosmin 1 (NPM1) genes.1-6  CLN have not been reported on B-cell acute lymphoblastic leukemia (B-ALL), with the exception of rare single case reports.7-9  The incidence of CLN and their possible association with certain B-ALL subtypes or cytogenetic abnormalities are unknown.

To answer these questions, we retrospectively reviewed 425 B-ALL cases diagnosed at Children's Mercy Hosptal from January of 1996 to January of 2017. Patients had an age range of 10 days to 19 years (median,...

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