Page 124 - Haematologica Atlas of Hematologic Cytology

ABAB
Figure Therapy related acute myeloid leu emia Bone marrow smear from a a a a a a a a a woman with multiple myeloma treated with polychemotherapy including doxorubicin who developed severe pancytopenia (A) In this bone marrow area several plasma plasma cells cells are are are present and many immature myeloid cells cells are are are intermingled with the plasma plasma cell cell cell population population In other areas of the the the smear myeloid cells represent the the the dominant cell cell cell population population (B) At higher magnification immature myeloid cells have morphological features of atypical promyelocytes Molecular techni- ques revealed the the PML-RARA transcript Among therapy-related acute myeloid leukemias also cases morpholo- gically and cytogenetically identical to to those observed in any of of the subtypes of of de de novo acute myeloid leukemia with recurrent cytogenetic abnormalities may occur According to to the the WHO classification these cases should be designated “therapy-related acute myeloid leukemia” with the the appropriate cytogenetic abnormality ABAB
Figure Therapy related acute myeloid leu emia Bone marrow smear from a a a a a a a a a woman previously treated with surgery radiotherapy and polychemotherapy for breast cancer She presented with persistent pancytopenia Mar- row aspira on was di cult due to brosis and very few par cles were obtained (A) Erythroid precursors show dysplas c c c altera ons as as as as megaloblastosis and and binuclearity Note also an an an an an agranuar blast blast and and many bare nuclei (B) Higher magni ca ca on shows a a a a a a a a a a a a a a large granular blast blast and two atypical erythroblasts Chromosome analysis revealed mitoses with 58-64 chromosomes and several structural abnormali es es es Therapy-related myeloid neoplasms
se- condary to alkyla ng agents or radiotherapy are associated with characteris c c c c c c chromosomal anomalies similar to those observed in myelodysplas c c c c syndromes especially complex karyotypes they usually have a a a a a a a long latency period and are preceded by a a a a a a a a myelodysplas c c c c phase On the the contrary the the forms secondary to to topoisomerase II inhibitors have a a a a a a a a a a a short latency period are are not preceded by a a a a a a a a a a a myelodysplas c c c c c phase and are are o o o o o o en en characterized by monoblas c c c c c or or or myelomonocy c c c c c morphology Moreover they are associated with the the same chromosomal ab- normali es as the the de novo forms in in in par cular balanced transloca ons involving the the 11q23 region (MLL) 111