| Session: Myelodysplastic / myeloproliferative disease |
| Case number: 189 |
Submitter(s): Bachir Alobeid, Govind Bhagat.
Clinical history
64-year-old female patient with h/o pancytopenia, no significant prior clinical history, no history of malignancy or chemotherapy, no palpable splenomegaly
CBC: WBC: 4.7x10*9/l, RBC: 2.68x10*12/l, HGB: 8.1g/dl, MCV: 86.3 fl, MCHC 34.6 g/dl, PLT: 142x10*9/l.
Medications: No relevant medication history.
Details of gross/microscopic pathology:
Bone marrow, iliac crest, biopsy, Bouin's fixative, 30 min decal in Stat decal. Hypocellular marrow (20%) with diffuse and marked (3+) fibrosis (reticulin and trichrome). Hypoplastic and left shifted erythroid elements. Myeloid elements show full maturation. Megakaryocytic hyperplasia with dysplasia.
Immunophenotype (flow cytometry/immunohistochemistry):
By immunohistochemistry no increase in CD34+ blasts. CD61 confirmed the morphologic findings of megakaryocytic hyperplasia and dysplasia. Pancytokeratin, S-100, CD30, AFB and GMS are all negative. No evidence of lymphoma on staining for CD20, CD30, and CD3 stains.
Flow cytometry was not done because of a dry tap.
Cytogenetics:
Peripheral blood: G-banded karyotype: 46,XX [20]. No evidence of del(20q), del(5q), del (7q) and trisomy 8 by FISH.
Molecular analysis:
Molecular analysis was not done because of a dry tap.
Interesting feature(s) of submitted case:
Although there are overlapping clinical and morphologic features suggestive of MDS and/or MPD, overall findings are not quite diagnostic of either entity.
Proposed diagnosis:
Atypical myelofibrotic process suggestive of an atypical myelodysplastic/myeloproliferative disorder?
Panel diagnosis:
Favored diagnosis: MDS with fibrosis
Comments:
Stains performed by the panel: CD34 and CD117 within normal limits, CD42b highlights dysplastic megakaryocytes
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