Page 89 - Haematologica Atlas of Hematologic Cytology

CHAPTER 11 - Myelodysplastic/myeloproliferative neoplasms
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Figure 15 Myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis (MDS/ MPN-RS-T) (A) Peripheral blood smear from a a a a a a a a 73-year-old male presenting with macrocytic anemia reticu- locytopenia mild leukopenia and persistent thrombocytosis (platelets 820x109/L) demonstrates slight aniso- poikilocytosis a a a a a a a a a normal neutrophil and platelet anisocytosis (B) Bone marrow (BM) smear from the same case showing erythroid hyperplasia with macroblastoid changes (C) In the same BM smear numerous large often clustered megakaryocytes similar to those observed in the BCR-ABL1-negative myeloproliferative neoplasms
are observed (D) Perls’ stain reveals the presence of numerous ring sideroblasts with at least 5 positive granules surrounding a a a a third or or or or more of of the the circumference of of the the nucleus According to World Health Organization (WHO) criteria a a a a a a a a a diagnosis of of of MDS/MPN-RS-T was made on the the basis of of of ring sideroblasts being at least 15% of of of the the erythroid cells cells and blasts less than 5% of all BM cells cells Karyotype was normal while mutational analysis revealed mutation of of the the SF3B1 and JAK2 V617F genes confirming the the hybrid nature of of this myeloid neoplasm 76