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Patient with anemia

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楼主 发表于 2010-05-02 09:53|举报|关注(0)
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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 !!!!
  • Patient with anemia图1
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  • Patient with anemia图2
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  • Patient with anemia图3
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  • Patient with anemia图4
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  • Patient with anemia图5
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1 楼    发表于2010-05-11 19:12:00举报|引用
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 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?

WHO分型,第1条,伴有重现性遗传学异常的白血病,包括t(8,21)染色体异常,所以可以诊断AML,不管原始细胞是否大于20%。

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2 楼    发表于2010-05-10 12:20:00举报|引用
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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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3 楼    发表于2010-05-10 11:34:00举报|引用
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Fig. 2
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4 楼    发表于2010-05-10 11:30:00举报|引用
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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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5 楼    发表于2010-05-05 20:36:00举报|引用
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 流式太漂亮了,MICM分型的话,希望能看到染色体和分子生物学检查结果,那太完美了!
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6 楼    发表于2010-05-05 13:05:00举报|引用
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以下是引用侯军在2010-5-5 5:43:00的发言:

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? 

这里选择了一些流式细胞仪检查的结果。另外,原始细胞CD15, HLA-DR, CD16/56和MPO阳性,而T和B细胞标记阴性。这是急性髓系白血病。什么类型?对于该病人我们还能做些什么事情?

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7 楼    发表于2010-05-05 10:54:00举报|引用
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   仅看骨髓像细胞形态考虑急粒  M2a 但不除外M2b,
 建议排查t(8,21)染色体异常

骨髓活检HE染色看的少没经验,请喉老师指教。
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8 楼    发表于2010-05-05 09:46:00举报|引用
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 搬个板凳,过来学习,谢谢楼主老师
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9 楼    发表于2010-05-05 05:43:00举报|引用
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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? 
  • 图1
  • 图2
  • 图3
  • 图4
  • 图5
  • 图6
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10 楼    发表于2010-05-03 22:20:00举报|引用
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 急粒
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朱正龙

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11 楼    发表于2010-05-03 21:54:00举报|引用
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 有骨髓涂片吗?

应该是急粒,分型要看骨髓涂片。

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12 楼    发表于2010-05-02 22:50:00举报|引用
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  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!

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13 楼    发表于2010-05-02 20:16:00举报|引用
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谢谢侯老师不辞幸苦发贴!第一次贴图就成功了,不错的噢!

本人平时看血液病看得极少,非常需要学习。试着看看本例:觉得骨髓像不正常,异型细胞增生,具单一性,核大、淡染、部分核偏位,不知道会不会是骨髓瘤,似乎病人年龄尚不足支持骨髓瘤。

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14 楼    发表于2010-05-02 20:02:00举报|引用
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 建议排查t(8,21)染色体异常
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15 楼    发表于2010-05-02 20:00:00举报|引用
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 细胞涂片太不清晰了,骨髓活检片子很不错!
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16 楼    发表于2010-05-02 14:10:00举报|引用
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以下是引用侯军在2010-5-2 9:53:00的发言:

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 !!!!

临床病史:54岁男性,贫血。外周血涂片显示原始粒细胞。进行骨髓活检。实验室检查:血色素8.0g/dl, WBC7.8k/ul, 其中原始粒细胞占24%, 血小板76000/ul。

这是我第一次发帖,随后我会发出流式细胞仪的结果。

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17 楼    发表于2010-05-02 10:02:00举报|引用
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Try again
  • 图1
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18 楼    发表于2010-05-02 10:00:00举报|引用
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 I do not know why these few pictures were missed the first time.
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