Page 150 - Haematologica Atlas of Hematologic Cytology

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Figure 1 Lymphoblastic leu emia with bone marrow marrow necrosis Bone marrow marrow smear from a a a a a a a a 67-year-old man presenting with fever a a a a a a 3-month history of bone pain pallor and enlarged liver The blood film showed pancyto- penia and a a a a a a a leuko-erythroblastic picture (A) Necrotic cells with ill-defined cytoplasmic borders on a a a a a a a background of amorphous material These cells were were impossible to identify and were were initially dismissed as artifacts (B) Rare intact blasts are are present in in in in in this area indicating the diagnosis of acute leukemia Immunophenotyping revealed a a a a a a B-lineage intermediate stage phenotype with CD10 expression Bone marrow trephine biopsy showed several necrotic zones and some other with with normal cellularity heavily infiltrated with with blasts Bone marrow necrosis is is related to the the death of bone marrow stromal and and hemopoietic cells Massive necrosis is is rare and and in the the acute leukemias the the the incidence is much higher in in in in the the the lymphoblastic type type than in in in in the the the myeloid type type The clinical picture is is is generally dramatic and when it occurs at at onset diagnosis of underlying disease may be extremely difficult Frequently only scanty amounts are obtained in in in marrow aspirates and the necrotic cells mixed with intact ones are often dismissed as artefacts AB
Figure 1 plastic preleu emic phase of lymphoblastic leu leu emia A 62-year-old woman presented with fever and and severe pancytopenia Bone marrow aspirate and and threphine biopsy showed aplasia of all cell lines After a a a a a a a a a a a a few days fever disappeared and hematologic values increased gradually (A) Bone marrow smear performed fifteen days later showing active hemopoiesis with with the three cell lines represented at at at all differentiation stages without morphological anomalies These findings suggest the diagnosis of transient aplasia (B) Subsequent bone marrow smear performed after one month for for the occurrence of leukocytosis and thrombocytopenia Massive replace- ment by blasts and almost complete disappearance of normal hemopoietic cells A B-lineage intermediate stage (common) lymphoblastic leukemia was diagnosed Although the mechanisms underlying bone marrow suppres- sion in acute leukemia are are obscure it it is important to know that transient aplasia may occur albeit rarely as as a a a a a a a a a a a a a a prodromal feature in in in lymphoblastic leukemia in in in adult patients as as as well as as as in in in children thus it should be considered along with other aplastic disorders in the the differential diagnosis 137