Severe neutropenia is present. Numerous blasts are seen and are medium size to large in size. The blasts have mildly condensed to fine chromatin, prominent nucleoli, increased N/C ratio, and mild amount of basophilic cytoplasm. Mild normocytic normochromic anemia is noted with mild anisopoikilocytosis and polychromasia. Few tear-drop cells and target cells are seen. Mild thrombocytopenia with unremarkable platelet morphology is noted.
BONE MARROW CORE BIOPSY AND CLOT SECTION:
The overall cellularity is 95% and the cellularity ranges from 90 to 100%. Sheets of blasts comprising 90% of overall cellularity are noted. The blasts are positive for CD79a and TdT, but negative for MPO, CD3 and CD20.
BONE MARROW ASPIRATE SMEAR AND TOUCH IMPRINTS:
Numerous blasts are seen, comprising about 90% of the overall cellularity. The blasts have similar features to those described in the peripheral blood.
Blasts: 90%, Promyelocytes: 1%, Myelocytes: 1%,
Metamyelocytes: 2%, Bands: 2%, Neutrophils: 1%,
Eosinophils: 1%, Lymphocytes: 1%, Plasma cells: 1%.
|FLOW CYTOMETRY INTERPRETATION|
The blasts express CD34, TdT, CD79, CD13, CD19, CD10, CD38, and HLA-DR.
Total events H gate Dim CD45+ A gate Bright CD45+
analyzed = 51524 events = 44325 (89% of events=1571 (3% of
totalnucleated cells) total nucleated cells)
CD45+/CD14- 98% 98%
TOTAL CD14+ <2%
TOTAL CD13+ 73%
TOTAL CD15+ <2%
TOTAL CD33+ 5%
TOTAL CD34+ 99%
TOTAL CD11b+ 17%
TOTAL CD41+ <2%
TOTAL HLA DR+ 99%
CD34+/HLA DR+ 99%
TOTAL CD19+ 95% 30%
CD19+/CD20+ <2% 29%
CD19+/CD38+ 96% 28%
CD19+/CD10+ 87% 3%
CD2+/CD7+ <2% 59%
CD3+/CD5+ <2% 62%
CD3+/CD4+ <2% 33%
CD3+/CD8+ <2% 29%
CD3-/CD56+ <2% 6%
Cytogenetic and FISH studies:
Cytogenetic results: 48,XY,t(9;22)(q34;q11.2),+21,+der(22)t(9;22)
INTERPRETATION: Cytogenetic analysis revealed the presence of an abnormal hyperdiploid clone characterized by t(9;22)(q34;q11.2), an extra copy of the Philadelphia chromosome, and trisomy 21.
FISH results: Positive for variant BAR/ABL fusion in 98% of cells.
INTERPRETATION: ABNORMAL. Molecular cytogenetic studies revealed the presence of the molecular rearrangement associated with the Philadelphia chromosome in 98% of the interphase nuclei from this specimen. Specifically, this patient's signal pattern was characterized by a deletion of 9q34 and 22q11 along with an extra copy of the Philadelphia chromosome. These deletions cannot be visualized cytogenetically.
Paraffin immunohistochemical staining:
|B-cell acute lymphoblastic leukemia, transformed from CML|