Page 72 - Haematologica Atlas of Hematologic Cytology

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Figure 1 . hronic eosinophilic leu emia ( L) not otherwise speci ed. (A) Peripheral blood smear from a pa- ent with persistent eosinophilia showing mature eosinophils (le ) and a eosinophilic myelocyte (right). Note the presence also of basophilic granules in the cytoplasm of the myelocyte. (B) Bone marrow smear reveals increased cellularity with hyperplasia of the eosinophilic lineage. Monosomy 7 was demonstrated by karyotyping. Diagnosis of CEL is based on the following criteria: eosinophil count ≥1.5x109/L; exclusion of all other myeloprolifera ve neo- plasms, myelodysplas c/myeloprolifera ve neoplasms, myeloid/lymphoid neoplasms with eosinophilia and acute myeloid leukemias, with the inclusion of those with recurrent gene c abnormali es; evidence of clonal cytogene c or molecular gene c abnormalty or blast count≥2% in the peripheral blood or ≥5% and <20% in the bone marrow. In CEL, the most characteris c feature is persistent hypereosinophilia with a prevalence in the peripheral blood of mature eosinophils and a small percentage of eosinophilic myelocytes and promyelocytes, with various morphologi- cal abnormali es, similar to those observed in reac ve eosinophilia: hypo-granularity, vacuoliza on, nuclear hypo or hypersegmenta on; blasts are less than 20% in the peripheral blood and bone marrow. In the absence of cytogene c or molecular abnormali es, a possible increase in the blast percentage can support the diagnosis (Bain et al., 2017).
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Figure 1 . Myeloprolifera ve neoplasm unclassi able (MP ). (A) Peripheral blood smear from a man presen- ng with thrombocytosis and neutrophil leukocytosis shows moderate anisopoikilocytosis with rare dacryocytes and a large sheet of platelets surrounding a micromegakaryocyte nucleus (center). (B) Bone marrow smear reveals hypercellularity with marked megakaryocyte prolifera on. Megakaryocytes have hypolobated nuclei and some na- ked nuclei are present. BM biopsy demonstrated mild brosis. A JAK2 muta on was found. The MPN- group inclu- des cases that present clinical, laboratory and morphological features compa ble with the diagnosis of MPN, but that do not have the criteria to t into one of the MPN speci c categories. According to the World Health Organiza- on classi ca on, the diagnosis requires that all the following 3 criteria are met: 1) features of MPN; 2) exclusion of any other MPN, myelodysplas c syndrome or myelodysplas c/myeloprolifera ve neoplasm; 3) JAK2, CALR or MPL muta on or presence of another clonal marker or absence of a cause of reac ve brosis (Kvasnicka et al., 2017).
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