Page 115 - Haematologica Atlas of Hematologic Cytology

CHAPTER 13 - Acute myeloid leukemia and related precursor neoplasms
Figure cute promyelocy promyelocy c c c c c c c c c c c leu emia with with PML-RARA hypergranular type Hypercellular marrow with with almost complete replacement of normal hemopoie c c c c c c c c c c c c c c c c cells cells by atypical promyelocytes Their cytoplasm is is packed with azurophilic granules some some mes so so so numerous that the the the nuclear outline is is is obscured In In many cells cells cells cells there are are several Auer bodies o o o o o o o o o o o o o o o o o en en collected in in in in bundles (faggot cells) In In In some some cells cells cells the the the cytoplasm is is lled with ne ne ne dust-like granules giving a a a a a a a a a a a a a a a a di di di used pink color The nuclei are are are o o o o o o o o o o o o o o o o o o o en en kidney-shaped or or or or or bilobed In In leukemic promyelocytes unlike in in in in in normal or or or or or or reac ve ve ve ones the the the clear clear paranuclear area corresponding to the the the Golgi zone is never observed There are are no no dysplas c c c c c c c c c altera ons of the the the erythroid or or or or megakaryocy c c c c c c c c c lineage AB
Figure Figure cute promyelocy c c c c c c c c c c leu emia with PML-RARA hypergranular type Bone marrow smear from the same case as as as as as Figure Figure 2 Promyelocytes are strongly posi ve ve for for Sudan black (A) and and peroxidase reac reac reac ons The reac reac reac on on on on on product covers the the the whole cytoplasm and and o o o o o o o o o o o o o o o o o o o o o o o o o o o en en also also the the the nucleus (B) Chloro-acetate esterase esterase reac reac reac reac on on on on on on which is speci speci c c c c c c c c c c c c c c c c c c c c c for for for granulocy c c c c c c c c c c c c c c c c c c c c c di di di eren a a a a a a a a a a a a a a a a a a a on on on on detects the the the Auer bodies Leukemic promyelocytes may show show reac reac vity also also for for non-speci c c c c c c c c c c c c c c c c c c c c esterase esterase inhi- bited by sodium uoride (monocy c c c c c c c c c c c c c type) In this case cytogene cs showed t(15 17)(q24 1 1 1 1 q21 2) as as as as an an an isolated anomaly in in many metaphases while molecular study revealed the the the PML-RARA fusion gene gene con rming the the the diagnosis diagnosis The abnormal nuclear distribu on on on of of PML PML detectable by immuno uorescence may also be useful for the the the diagnosis diagnosis Hypergranular acu- te te promyelocy c c c c c c c c c leukemia frequently occurs with marked leukopenia and low percentage of of peripheral blasts 102