Medium power view of first bone marrow biopsy showing a hypercellular marrow with left shifted myeloids and erythroids.
High power view of first bone marrow biopsy showing maturing trilineage hematopoiesis and increased monocytic cells.
High power view of first bone marrow aspirate showing erythroid dysplasia, monocytes, and occasional myeloid blasts.
NPM1 immunostain of first bone marrow biopsy showing aberrant cytoplasmic expression in hematopoietic elements.
Low power view of second bone marrow biopsy showing a hypercellular marrow composed mainly of blast forms.
High power view of second bone marrow biopsy showing sheets of immature monocytoid cells with irregular and lobated nuclei and prominent nucleoli, consistent with promonocytes and monoblasts.
High power view of second bone marrow aspirate showing predominantly blasts and promonocytes.
NPM1 immunostain of second bone marrow biopsy showing aberrant cytoplasmic expression in the blast population.