Page 123 - Haematologica Atlas of Hematologic Cytology

CHAPTER 13 - Acute myeloid leukemia and related precursor neoplasms
Figure 1 Therapy related acute myeloid leu e e e e e e e e mia Bone marrow smear from an an 81-year-old man treated with melphalan for multiple myeloma three years later he presented with macrocytic anemia thrombocytopenia and leukocytosis with dysplastic neutrophils and rare blasts in the pe- ripheral blood Bone marrow cellularity is high: there are many plasma cells and a a a a a a high proportion of of blasts marked hypoplasia of of the erythroid and granulocytic and megakaryocytic lineages Figure 0 Therapy related acute myeloid leu e e e e e e e e mia Higher magni ca on on of the same bone mar- row smear as in in Figure 19 showing medium-large sized blasts with abundant agranular o o en vacuo- lated cytoplasm Note also three plasma cells Figure 1 Therapy related acute myeloid leu e e e e e e e e mia Bone marrow smear from the same case as as Figures 19 and 20 Alpha-naphthyl-acetate este- rase reaction reveals strong cytoplasmic positi- vity in in most blasts suggesting the diagnosis of acute monoblastic leukemia This diagnosis was confirmed by immunophenotyping In 20-30% of cases the the first manifestation of therapy-related myeloid neoplasm is acute leukemia without a a a a preceding myelodysplastic phase and many of these cases have monoblastic or myelomonocytic morphology 110