Page 117 - Haematologica Atlas of Hematologic Cytology
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CHAPTER 13 - Acute myeloid leukemia and related precursor neoplasms
Figure cute promyelocy c c c c c c c leu emia with PML-RARA microgranular variant A A A 5-year-old girl was admi ed ed ed because of fever and and and cutaneous purpura on on both legs Physical examina on on revealed pallor mild hepatomegaly and and and splenomegaly A blood count showed anemia thrombocytopenia and and and leukocyto- sis sis (186 5x109/L) with with 100% atypical immature cells cells There were laboratory ndings consistent with with DIC (A) Circula ng ng ng ng cells cells are large and and have irregular bilobed indented or or or or reniform nuclei Nuclear windows showing the the underlying cytoplasm cytoplasm may be be present The rather abundant cytoplasm cytoplasm is is basophilic and and pre- dominantly agranular A A few cells cells contain ne ne dust-like azurophilic granules (B) Bone marrow is is hypercel- lular with with with a a a a a a a a a a a a a a a a a a monomorphic picture Rarely cells cells cells with with with mul mul ple ple Auer rods or or or or oval or or or or ellip form inclusions are are observed (C) Some cells cells cells have irregular nucleus and and hyperbasophilic cytoplasm with with with with mul mul ple ple pro ec ons ons (D) Leukemic cells cells cells are are strongly posi ve ve ve ve with with Sudan black (le ) ) ) ) peroxidase (right) and and chloro-acetate esterase esterase stains most cells cells are are also reac ve ve ve for alpha-naphthyl-acetate esterase esterase The diagnosis of acute promyelocy c c c c c c c c c c c c c c c c c leukemia microgranular variant suggested by by the dis nc ve ve cytological and and and cytochemical features was con rmed by by immunophenotyping and and and and and and gene gene cs Leukemic cells were CD9 CD13 and and and and and and CD33
posi ve ve and and and and and and nega ve ve to to CD11 CD14 CD34 and and and and and and HLA-DR Cytogene c c c c c c c c and and and and and and molecular analysis showed t(15 17)(q22 q12) and and and and a a a a a a a a a a a a a a a a a a a a a a a a a PML-RARA fusion gene gene In this leukemia atypical promyelocytes are are are apparently agranular because of of of of the the submicroscopic size of of of of the the azurophilic granules However a a a a a a a a a a a a a a a a a a a a a a a a a a a careful examina on on on on on of of of of bone marrow smears 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 en shows a a a a a a a a a a a a a a a a a a a a a a a small popula on on on on of of of of hypergranular promyelocytes occasionally with with mul ple Auer rods Cytochemistry and and immunophenotyping are useful in in the di di di eren al al al diagnosis diagnosis with with acute acute monocy c c c c c c c c c c c c c leukemia leukemia and and and gene cs can con rm diagnosis diagnosis In microgranular acute acute promye- locy c c c c c c c c c c c c c c c c leukemia leukemia the the the leukocyte count is is is is is usually very high and and as in the the the hypergranular type there is is is is is evi- dence of DIC Therefore a a a a a a a a a a a a a a a rapid diagnosis is is is is essen al al al to avoid early lethal hemorrhagic complica ons 104
































































































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