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- Patient with anemia
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Clinical History.
54 y/o male patient found to be anemic. Upon review of peripheral blood smear, blasts present. Bone marrow biopsy performed.
Lab. Hgb 8.0g/dL, WBC 7.8k/ul with blasts 24%, Platelet 76,000/ul
This is the first time for me to post a case. I will post the flow cytometry study later.
五 一 节 快 乐 ！！！！
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| 以下是引用天山望月在2010-5-2 22:50:00的发言： 谢谢侯老师！ 骨髓涂片：原始细胞24%，骨髓组织大量成片原始细胞，白血病可以定。 细胞浆蓝色，染色质有点细腻，像淋，而骨髓明显的粒细胞分化谱系，又像粒，总之需组化或流式及基因检测确定。 因看骨髓组织片少，原始粒、原单和原淋在组织片中不知有哪些鉴别点，还望侯老师指点迷津，谢谢！ |
| From our website, I know that you are a very experienced pathologist. 我们互相学习。 There are some minor different features between myeloid, lymphoid and monocytic blasts. Myeloblasts may have large nuclear with prominent nucleoli and more cytoplasm. Lymphoblasts often have smaller nuclear and scant cytoplasm. Monoblasts often have large irregular shaped nuclear. All these features are relative. We have flow cytometry and marrow aspirate smear on all most all the bone marrow biopsies. Therefore, we already know the morphology and phenotype of the acute leukemia before we get the biopsy section. The tissue section itself gives very little more information about the leukemia unless you want to do immunohistochemical study. If it is a transformed acute leukemia, the biopsy section is very useful to determine if patient had prior MDS or MPD. |
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This is a case of acute myeloid leukemia with t(8:21) (q22,q22). 海燕 曾建议排查t(8,21)染色体异常
. Good job.
The practical features for diagnosis:
1. Relatively low blast count, 24%
2. The marrow aspirate showed many large myeloblasts with basophilic cytoplasm.
3. Many large early myeloid cells (not blasts) have large amount cytoplasm with perinuclear clearing and abundant large pink granules
4. The H&E section shows diffuse mixed proliferation of variable stage of myeloid cells, many of these cells have pink granular cytoplasm.
5. The CD45 and side scatter plot (Flow cytometry Fig. 2) shows straight-up pattern with blast and rest myeloid cells. There is no clear separation between the blasts and mature myeloid cells. (very useful)
6. CD19 ( a B-cell marker) expression on the myeloid blasts. (very useful)
We use these morphologic features and flow findings to successfully predict several cases of AML with t(8:21).
I will request the cytogenetic study and FISH pictures to post here later. (If they did FISH on this case)
Now I have two more questions about this case:
1. We did c-kit mutation study on this case. It was negative. Why did we order this test.
2. If we only had 15% blasts in bone marrow as well as in peripheral blood, could we make the diagnosis of acute myeloid leukemia in this patient?
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These are the selected flow cytometry study results. In addition, the blasts are also positive for CD15, HLA-DR, CD16/56, MPO and negative for T- and B- cell markers. This is an acute myeloid leukemia. What type? What else we should do with this patient?
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