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Case 271 - Discussion

Uploaded: 2012-06-06, Updated: 2012-06-06

 

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 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