| Session: Myelodysplastic / myeloproliferative disease |
| Case number: 237 |
Submitter(s): Falko Fend
Clinical history
65-year old female with a nine months’ history of marked leukocytosis, moderate splenomegaly, otherwise no clinical symptoms. PB counts at time of Bx: Hgb – 12.4 gm/dl, Platelets – 204 G/L; Leukocytes 65.1G/L; neutrophils 82%; eos 1%; basophils – 0%, monocytes – 2%; band forms 5%; myeloc 1%; Lymphs 7%; no blasts. Bone marrow aspirate 1 % blasts. Minimal M-component in serum, but no evidence for MM
Details of gross/microscopic pathology:
BM trephine 2006, 1.2 cm, fixed in formalin, EDTA decalcified and paraffin-embedded. Microscopy: markedly hypercellular marrow with predominance of neutrophils and precursors, mild increase in megakaryocytes without cytological atypia, no classical micromegakaryocytes. Erythropoiesis reduced, mild disturbance in maturation. Increase in plasma cells wo. atypia. Mild increase in reticulin
Immunophenotype (flow cytometry/immunohistochemistry):
1. No increase in CD34+ mononuclear cells, increase in PC (CD138)
Cytogenetics:
Molecular analysis:
BCR-ABL neg.; JAK2 V617F negative.
Interesting feature(s) of submitted case:
Difficult differential diagnosis of Ph-, JAK2- CMPD. aCML is a JAK2 V617F negative disorder.
Proposed diagnosis:
Atypical chronic myeloid leukemia
Panel diagnosis:
agree with proposed diagnosis
Comments:
PowerPoint:
Presentation Link
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