Bone marrow aspiration of a 84-yer-old man with anemia (HGB 100g/L), leukocytosi (75x109/L) and thrombocytopenia (47x109/L). Blast cells in PB 37%. In the attached photos some microscopic field of PB (1) and of bone marrow (2-3).
I would like to discuss about this case with RG community
I am not a hematologist . I am in transfusion medicine
Pictures are of ? Acute Myloid Leukemia (AML).
Yes, it is wise to share our work on research-gate
Hi . Considering the information contained in the case and the pictures showing a large number of immature myeloid cells, especially promyelocytes. Therefore, it can be suspected of acute myeloid leukemia (AML) of type M3. To confirm the diagnosis, the Cytogenetic test study of t(15: 17) is required.
AML but which type? I wonder whether it could be FAB M7 (megakaryocytic). Any markers?
Best wishes
Siva
The morpholgical features of monocytes had been described in the WHO 2008 classification to differentiate monoblasts from pro-monocytes and pro-monocytes from abnormal monocytes (figure 1). Pro-monocytes are considered "monoblasts equivalents" when the percentage of blasts is required for the diagnose of different types of acute leukemias of monocyte lineage. It's important that abnormal monocytes are excluded from the blasts count.
Previous photos are from an acute monoblastic leukemia (acute myeloid leukemia not otherwise specified in the WHO classification; M5b in the FAB classification) and constitute an useful exercise to distinguish different types of monocytes. In the figure 2, a naphtyl butyrate esterase staining of bone marrow.
Acute Myeloid Leukemia by morphology
Sub classification requires Special stains and Immunohistochemistry.
As in numerous answers, I confirm that this is a case of AML without cytogenetic and molecular changes classifiable between AML not otherwise specified (WHO2008). All monoblasts (including pro-monocytes) and monocytes are butyrrate-esterase positive (see above figure 3). Blast cells were positive for CD 34 (11%), CD33, CD13, CD14 and CD 11c. MPO was negative
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