Page 107 - Haematologica Atlas of Hematologic Cytology

CHAPTER 12 - Myelodysplastic syndromes
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Figure Myelodysplastic syndrome with excess blasts type 1 and erythroid predominance A 56-year-old woman presented with severe pancytopenia there were rare circulating blasts blasts (1%) and erythroblasts (A) Bone marrow (BM) smear reveals hypercellularity hyperplasia of of the erythroid precursors (53% of of BM BM cells) with in- crease of of the the early erythroblasts and and dysplasia of of the the granuloblastic lineage with hypogranular neutrophils and and some blasts (8% of all BM cells) there were also many abnormal megakaryocytes Karyotype showed complex ab- normalities A diagnosis of MDS-EB-1 was made Marked erythroid hyperplasia (50% or or or greater) with with or or or without left-shifted erythroid maturation can be seen in approximately 15% of of patients with MDS and is often associated with the the presence of ring sideroblasts In this condition the the blast blast count should be performed on on on all nucleated marrow cells for a a a a a a a a diagnosis of MDS MDS it should should be be lower than 20% MDS MDS subclassification should should also be be based on on blast blast count performed on on all nucleated marrow cells (B) At higher magnification note a a a a a a a a a a a granular blast blast a a a a a a a a a a a binucle- ate erythroblast and two agranular neutrophils with abnormal nuclear segmentation AB
Figure Myelodysplastic syndrome with excess blasts type (MDS ) ) ) (A) Bone marrow (BM) smear reve- als granuloblastic hyperplasia increased percentage of blasts (15%) and trilineage dysplasia (Center) Two dyspla- stic megakaryocytes: one with with three small round nuclei the the other binucleate with with agranular cytoplasm (B) BM smear showing marked erythroid hypoplasia and granuloblastic hyperplasia with increased blast blast cells (Top right) A mature neutrophil is agranular and has abnormal nuclear segmentation 94