Page 24 - Haematologica Atlas of Hematologic Cytology

B- or T-cell neoplasms Osteoblasts that that resemble plasma cells and osteoclasts that that are are as as as as as large as as as as as megakaryocytes are are infrequent-
ly found but if not recognized they can lead to diagnostic errors Macrophages usually have an an oval nucleus with at at least one rather prominent nucleolus and reticular chroma-
tin pattern Their cytoplasm is is pale frequently vacuolated and often filled with debris of of phagocytized cells or organisms or or or hemosiderin Some morphological features have diagnostic power such as the phagocytosis of red cells cells leukocytes and platelets in hemophagocytic syndrome the presence of parasites Gaucher cells cells Metastatic tumor cells are are often grouped in clusters Their nuclei are are irregular and and hyperchromatic and and va- cuoles are are are seen in in in the the cytoplasm cytoplasm cytoplasmic margins are are are poorly delineated They are are are often found near the the edges of the smear The rare occurrence of BM necrosis or or amyloid should be reported As previously mentioned iron iron iron stain detects marrow iron iron iron storage or or or iron iron iron metabolism abnormalities and should be applied as as routine practice to marrow films from the initial BM aspirate
of each patient Table 4 Morphological features of the granulocy c c c lineage Diameter m m ucleus ytoplasm Myeloblast
12-20
Round occupies almost all cell volu- me very loose chroma n n n 2-5 nucleoli
Basophilic
Promyelocyte
15-25
Round or oval eccentric rather dense chroma n n n n n n prominent nucleolus Basophilic
with large pale paranuclear area voluminous azurophilic granules
Myelocyte
10-18
Round or oval o o o o o o o en en eccentric clum- ped chroma n n n n n n no nucleoli
Weakly basophilic scanty azurophilic granules
granules
variable number of secon- dary granules
granules
Metamyelocyte
10-15
Indented or kidney-shaped coarse chroma n n n n n n no nucleoli
Weakly acidophilic numerous secondary (speci c) granules
ranulocyte
eutrophil osinophil asophil 10-14 12-17 10-16
Band in in young cells cells segmented in in mature cells cells coarse chroma n n n n n n 2-5 segments segments 2 2 segments segments Clover aspect
Yellow-pink colorless
Small neutrophilic granules
Large Large eosinophilic (orange) granules
granules
Large Large purple-black basophilic granules
also supranuclear
Table 5 Mega aryocyte di eren a a a a a on stages The final report should contain all the the the information listed in in in in in in Table 6 including the the the adequacy of the the the smears
and the the presence or or absence of of particles Quantitative and qualitative information on on on the the maturational sequence of of each cell cell line and the presence of of morphological abnormalities should be provided The percentage of of blast cells and and the number of lymphocytes and and plasma cells should be be counted
A possible increase in in macrophages as as as well as as as as their morphological abnormalities should should be reported as as as as should should any increase in in mast cells or or or or the the presence of degenerated cells and and naked nuclei Finally information should be provided on on on iron deposits and and the diagnostic conclusions that have been made A qualitative and quantitative evaluation with a a a a a a a a a a a a myelogram requires the presence of particles a a a a a a a a a a a a good quali- ty
ty
ty
smear and and increased normal or or only slightly reduced cellularity (Bain and and Bailey 2011) If the the quality of the the preparation is is is poor and/or cellularity is is is very reduced only qualitative evaluation is is is possible A sample without particles in the the absence of megakaryocytes or or any other precursors should be considered not assessable Mega aryoblast
Promega aryocyte Mega aryocyte Diameter m m 14-18
15-40
30-150
ucleus Round Indented Mul lobed
ucleoli
2-6
Variable
Not visible
hroma n Homogeneous
Condensed
Deeply condensed
ytoplasm Basophilic
Basophilic
and granular
Eosinophilic and granular
budding platelets The results of of the the BM aspirate
should always be compared with those of of the the trephine biopsy whenever this
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