Page 70 - Haematologica Atlas of Hematologic Cytology

Figure 11 Primary myelo brosis micromega aryocy c c c transforma on An old man presented with asthenia and and dyspnea Twenty years before he he had been found to have PMF and and was treated with hy- droxyurea He had massive hepatosplenomegaly Laboratory ndings: hemoglobin 6 g/dL WBC 153x109/L platelets 197x109/L Peripheral blood smear reveals anomalies of the the erythroid and granulocy c c c cells the- re re are also heterogeneous mononuclear mononuclear cells including blasts and giant platelets Some mononuclear mononuclear cells have lymphocyte-like features with with minimal cytoplasm some mes with with perinuclear spikes other cells are larger have an eccentric nucleus basophilic cytoplasm cytoplasm cytoplasmic protrusions or budding AB
Figure Figure 1 Primary myelo brosis micromega aryocy c c c c transforma on Peripheral blood from the same case as as in Figure Figure 11 (A) Cells with eccentric nucleus basophilic cytoplasm cytoplasm and cytoplasmic protrusions Chroma n n n n n n n n n is condensed no nucleoli There are are also a a a a a a a a a a a a a granulocyte precursor and and an an an an undi eren ated blast The The platelets greatly vary in size and and some mes are are agranular (B) Immunocytochemistry using an an an an an an an an CD61 monoclonal an an an an body demonstrates the megakaryocy c c c c c nature of the the small mononuclear cells and of the the blasts Also platelets are strongly posi ve (immunoalkaline-phosphatase technique) A A diagnosis of of of micromegakaryocy c c c leukemia as as transforma on of of of PMF PMF was made Approximately 15% of of of pa ens with PMF PMF develop terminal blast blast crisis (≥20% blasts in in the the peripheral blood and/or bone marrow) usually either myeloblas c c or or mye- lomonocy c c c c c c c c whereas the the the presence in the the the blood of of immature cells exclusively of of the the the megakaryocy c c c c c c c c type is uncommon 57