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Case 271 - Discussion

Hematopathology Case

 

Markedly Left-Shifted Marrow

  • The outside marrow biopsy contains many promyelocytes on the aspirate smear, which account for approximately 25% of marrow cells. The trephine biopsy also shows clusters of precursor myeloid cells. The myeloblasts are slightly increased (4.5%). The promyelocytes reveal no atypical features and no dysplasia is present on other lineages.

  • The case was diagnosed as acute myeloid leukemia by an outside institution, and the patient was sent to COH for treatment. Upon review of the outside sides, we consider this as a left-shifted marrow and no evidence of AML.

  • The patient was closely observed for several weeks, and another marrow biopsy at COH demonstrates normal marrow (see below).

  • Upon further investigation of clinical history, the patient received G(M)-CSF at the outside institution several days before the marrow biopsy.

  • NOTE: left-shifted marrow due to treatment or infection may closely mimic AML; clinical history and careful examination of the aspirate smear are crucial to reach an accurate diagnosis. Flow cytometry for aberrant markers (if any) and cytogenetic/molecular studies for chromosomal abnormalities (if any) are also very helpful.

     
 
 

Trephine biopsy. HE, 40

Trephine biopsy. HE, 40

 
 

Trephine biopsy. HE, 40

Trephine biopsy. HE, 40