Page 129 - Haematologica Atlas of Hematologic Cytology

CHAPTER 13 - Acute myeloid leukemia and related precursor neoplasms
AB
CD
EF
Figure Pure erythroid leukemia (A) Peripheral blood lm showing remarkable anisopoikilocytosis of red cells and numerous morphologically abnormal erythroblasts (Bo om om om le le le le ) ) ) A A blast blast cell cell cell (B) Bone marrow Monomorphic in in ltra- on on on by very immature and and atypical erythroid precursors These large cells have round nuclei with with re re re cular chroma n n n n n n n n n n n n n n n n and and and prominent nucleolus hyperbasophilic agranular o o o o o o o o o o o o o o o o o o o o en en vacuolated cytoplasm (C) Group of proerythroblasts with with megaloblas c c c c c c c c c c c features 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 a a a a a a a voluminous paranuclear clear clear area (D) Perls’ staining shows several ring sideroblasts (E) Periodic acid acid Schi (PAS) stain stain is strongly posi ve ve with 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 a a a a a a a a granular pa pa pa pa ern ern in in in in in in in the early erythroid precursors 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 a a a a a a a a a a di di use pa pa pa ern ern in in in in late erythroblasts erythroblasts (F) Leukemic erythroblasts erythroblasts show localized paranuclear reac vity for acid acid phosphatase Pure erythroid erythroid erythroid leukemia (FAB classi ca ca ca on on on on M6) is characterized by >80% of of erythroid erythroid erythroid precursors precursors in in the bone marrow with with ≥30% proerythroblasts and a a a a a a a a a a a a a a a a a a a a a non-signi cant myeloblas c c c c c c c c c c c c c component Cases with with ≥50% of of of erythroid erythroid erythroid precursors precursors are are classi ed ed on on on on the the basis of of of the the total bone marrow marrow or or or peripheral blood blood cell cell count as as as as as as as as as as myelodysplas myelodysplas c c c c c c c c c c c syndrome if if bla- sts sts are are are are <20% of of of all all marrow marrow or or or blood blood cells cells and and as as as as as as as as acute myeloid leukemia leukemia with with myelodysplasia-related changes if if blasts are are are ≥20% of of the cells cells Pure erythroid leukemia leukemia is is extremely rare and and generally associated with with a a a a a a a a a a a a a a a a a a a a very poor prognosis 116