Figure 1. Review of microscopic findings from specimen 1. (A) Peripheral blood smear with numerous blasts, large in size with scant to moderate cytoplasm and some with fine azurophilic granules. No Auer rods were identified. Some of the blasts had slightly folded nuclear contours (500x). (B) Bone marrow smears showed markedly increased blasts with similar morphologic findings to that described in the peripheral blood smear (1000x). (C) and (D) Bone marrow biopsy showed 95% cellularity with sheets of large blasts with scant cytoplasm (C 200x; D 1000x). Figure 1. Review of microscopic findings from specimen 1. (A) Peripheral blood smear with numerous blasts, large in size with scant to moderate cytoplasm and some with fine azurophilic granules. No Auer rods were identified. Some of the blasts had slightly folded nuclear contours (500x). (B) Bone marrow smears showed markedly increased blasts with similar morphologic findings to that described in the peripheral blood smear (1000x). (C) and (D) Bone marrow biopsy showed 95% cellularity with sheets of large blasts with scant cytoplasm (C 200x; D 1000x).
Figure 2. Review of immunohistochemistry results from specimen 1. (A) Bone marrow clot section showed 95% cellularity and sheets of large blasts. Immunohistochemical studies were performed on clot sections that showed the blasts to be positive for CD19 approximately 50% (B), a subset for myeloperoxidase approximately 30% (C), PAX5 (D), and TdT (E). The blasts were negative for CD117 (F) (A-F, 400x). Figure 2. Review of immunohistochemistry results from specimen 1. (A) Bone marrow clot section showed 95% cellularity and sheets of large blasts. Immunohistochemical studies were performed on clot sections that showed the blasts to be positive for CD19 approximately 50% (B), a subset for myeloperoxidase approximately 30% (C), PAX5 (D), and TdT (E). The blasts were negative for CD117 (F) (A-F, 400x).
Figure 3. Review of microscopic findings from specimen 2. (A) and (B) Bone marrow smears showed increased blasts raging from small to intermediate, some with cytoplasmic granules. Maturing myeloid elements and erythroid precursors were markedly reduced with relative erythroid predominance (A, 500x; B, 1000x). (C) Myeloperoxidase (MPO) was weakly positive in approximately 20% of blasts when compared to the strong cytoplasmic stain of granulocytes. (D) Bone marrow biopsy showed a cellularity of 30-40% with interstitial clusters of immature cells (400x). Figure 3. Review of microscopic findings from specimen 2. (A) and (B) Bone marrow smears showed increased blasts raging from small to intermediate, some with cytoplasmic granules. Maturing myeloid elements and erythroid precursors were markedly reduced with relative erythroid predominance (A, 500x; B, 1000x). (C) Myeloperoxidase (MPO) was weakly positive in approximately 20% of blasts when compared to the strong cytoplasmic stain of granulocytes. (D) Bone marrow biopsy showed a cellularity of 30-40% with interstitial clusters of immature cells (400x).
Figure 4. Review of flow cytometric results on specimen 2 that showed 13% blasts (dim CD45) that were positive for CD34, CD123, CD13 partial, CD117 subset, CD33, CD19 moderate, CD22 partial, cytoplasmic CD79a dim, MPO small subset and TdT. Figure 4. Review of flow cytometric results on specimen 2 that showed 13% blasts (dim CD45) that were positive for CD34, CD123, CD13 partial, CD117 subset, CD33, CD19 moderate, CD22 partial, cytoplasmic CD79a dim, MPO small subset and TdT.