Peripheral blood, Wright Giemsa, 20x. A pancytopenia with moderate anisopoikilocytosis was evident at initial diagnosis.
Bone marrow aspirate, Wright-Giemsa, 60x. At initial diagnosis, dysplasia in both the erythroid and megakaryocytic lineages was evident.
Bone marrow aspirate image #2, Wright-Giemsa, 60x. At initial diagnosis, other areas show more overt erythroid dysplastic forms with abnormal nuclear contour.
Bone marrow core biopsy, H&E, 20x. The marrow at initial diagnosis is hypercellular for age.
FISH probe analysis at initial diagnosis demonstrating the presence of only one chromosome #7 signal (red); karyotype analysis revealed monosomy #7.
Peripheral blood, Wright Giemsa, 40x. At the more advanced stage of disease circulating blasts (10%) with monocytic morphologic features and an absolute monocytosis and basophilia are present.
Bone marrow aspirate image #1, Wright-Giemsa, 40x. At the more advanced stage of disease, increased numbers of blasts (29%) and similar multilineage dysplasia present.
Bone marrow aspirate image #2, Wright-Giemsa, 40x. At the more advanced stage of disease, increased numbers of blasts (29%) and similar multilineage dysplasia present.
Flow cytometry findings: At the more advanced stage of disease, flow cytometry revealed the blast population to express CD33, CD117, partial CD34, as well as aberrant partial CD7 and CD2. A small subset of blasts expressed cytoplasmic CD3, which was confirmed on back-gating of CD3 positive events.
Karyotype analysis at the more advanced stage of disease was again noteworthy for monosomy #7.