Abstract: Objective To investigate the morphological changes and related laboratory examination of variability acute promyelocytic leukemia（APL） with high expressions of CD14 and CD7,and to improve the accuracy of variability APL and reduce misdiagnosis. Methods All clinical data and the results of laboratory examination were collected. Results The morphology of this patient was similar to that of acute myelocytic leukemia（AML）-M5. The nuclear distortion was obvious. The cytoplasm had fine particles. The binuclear abnormal promyelocytic cells were common. Immunological antibodies routinely expressed CD13,CD33,CD117 and cytoplasm myeloperoxidase（cMPO）,accompanied by high expressions of CD14 and CD7. Qualitative screening of leukemia genes showed that PML-RARα fusion gene was positive,but NPM-MLF1 fusion gene was suspected positive. Conclusions APL is easy to mix with AML-M2 and AML-M5. Its morphology is similar to AML-M2. AML-M2 can be excluded by PML-RARαfusion gene-positive,cytogenetic t（15;17）（q22;q21） translocation. Some cell morphology is distorted and folded,and the cytoplasm has fine particles,which is similar to AML-M5. AML-M5 can be excluded by histochemical staining for peroxidase-positive and specific lipase-positive. It should synthesize clinical and laboratory examination to diagnose APL,and the diagnosis of APL is not affected by the expression of related antigens and the mutated fusion gene.

Key words: Acute promyelocytic leukemia, Variability, Immunological antibody, CD14, CD7, Fusion gene