78-year-old man previously diagnosed with Chronic Myelo Monocytic Leukemia. The Photos number 1 and 2 show granulocytic dysplasia and monocytosis (29 percent).The photo number 3 (Sudan black staining, about 95% of positivity) belies the presence and magnitude of monocytosis. The cells with "monocytic" morphology were dysplastic granulocytes!
The diagnosis was changed in "Refractory Cytopenia with Multilineage Dysplasia"
This is interesting. The nuclear morphology in some of the cells resembles that of a monocyte, yet the cells have a round shape, not an irregular one and of course, they stain with SB.
What of the monocyte count, then? For CMML to be diagnosed, an absolute count of >1000 monocytes per mm^3 is needed. Did you decide that the cells were miscounted as monocytes by the blood-cell analyzer?
The monocytes counted by the Sysmex XE2100 analyzer were more than 2000/mm^3 (18%) but the cluster was not well separated from lymphocytic cluster. I decided to verify the automatic and microscopic count with SB stain because very high differences were from different operators (from my 8% [ 900/mm^3] to 17%; 24% and 29% by other skilled operators). As conseguences of that a microscopic review of bone marrow after butyrrate esterase stain was performed (positive cells < 20%). Due to anemia and trombpcytopenia as well as to trilinear dysplasia in bone marrow, the diagnosis was changed in "Refractory Cytopenia with Multilineage Dysplasia"
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