The BM biopsy shows a hypercellular bone morrow with dysplastic megakaryocyte hyperplasia, and increased immature cells (H&E, 200x).The BM biopsy shows a hypercellular bone morrow with dysplastic megakaryocyte hyperplasia, and increased immature cells (H&E, 200x).
The BM aspirate smear shows trilineage dysplasia and 23% blasts. The blasts are intermediate to large with fine chromatin, prominent nucleoli, and scant to moderate amount of cytoplasm (Wright-Giemsa, 500x)..The BM aspirate smear shows trilineage dysplasia and 23% blasts. The blasts are intermediate to large with fine chromatin, prominent nucleoli, and scant to moderate amount of cytoplasm (Wright-Giemsa, 500x)..
The BM aspirate smear shows a pseuto-Pelger-Huet-like neutrophil (Wright-Giemsa, 1000x).The BM aspirate smear shows a pseuto-Pelger-Huet-like neutrophil (Wright-Giemsa, 1000x).
The BM aspirate smear shows a dysplastic micromegakaryocyte (Wright-Giemsa, 1000x).The BM aspirate smear shows a dysplastic micromegakaryocyte (Wright-Giemsa, 1000x).
Sanger sequencing analysis revealed a point mutation in exon 7 of the MDM4 gene (I175T).Sanger sequencing analysis revealed a point mutation in exon 7 of the MDM4 gene (I175T).