Virtual Slidebox
Presented by the MGH Pathology Service

Clinical history:

43 year old woman with anemia and thrombocytopenia. WBC: 17,400 (28% blasts, 40% lymphocytes, 17% monocytes, 12% neutrophils, 3% eosinophils).

Cytogenetics:

inv(16) – This cytogenetic abnormality can be very subtle. FISH should be ordered on cases with morphologic features of inv(16) and reportedly normal karyotypes, as this finding may influence therapy.

Read more on Acute myeloid leukemia with inv(16) (bone marrow – aspirate)…

Clinical history:

43 year old woman with anemia and thrombocytopenia. WBC: 17,400 (28% blasts, 40% lymphocytes, 17% monocytes, 12% neutrophils, 3% eosinophils).

Clinical history:

37 y/o female. WBC 108.7, Hct 27.4, Plt 163. Molecular testing positive for NPM1 mutation and FLT3 ITD mutation.

Bone marrow aspirate:

Bone marrow aspirate – Maturing erythroid cells comprise >50% of the marrow population, and blasts comprise >20% of the non-erythroid population.

Read more on Acute myeloid leukemia with mutated NPM1 (morphologically FAB M5B)…

Clinical history:

31 year old woman with anemia and thrombocytopenia. WBC: 9,400, no differential provided.

t(8;21) – This translocation involves RUNX1 (also known as AML1 or CBFA) at 21q22 and RUNX1T1 at 8q22. This finding defines AML, even in the absence of sufficient blasts in the marrow or PBL.

Read more on Acute myeloid leukemia with t(8;21) (bone marrow – aspirate)…

Clinical history:

31 year old woman with anemia and thrombocytopenia. WBC: 9,400, no differential provided.

Clinical history:

72 y/o female. WBC: 2.9, Hct: 24.2%, Plt: 29

Immunohistochemistry:

Clinical history:

61 y/o male. WBC 1.7, HCT 27.6, PLT 91.

Immunohistochemistry:

68 y/o male, 2 months status-post allogeneic BMT for AML.

Clinical history:

51 year old man with pancytopenia.

Cytogenetics:

t(15;17) – Fusion of the RARA (chr 17q12) and PML (chr 15q22) genes creates a fusion oncoprotein which defines APML, and mediates its responsiveness to all-trans retinoic acid (ATRA)

Read more on Acute promyelocytic leukemia, classic variant (bone marrow – aspirate)…

Clinical history:

51 year old man with pancytopenia.

Clinical history:

33 year old man with severe fatigue. WBC: 1,200. HCT: 33%. PLT: 15,000.

Cytogenetics:

Hyperdiploid karyotype – The finding of >50 chromosomes defines a subcategory of B-ALL with a unique gene expression profile and good prognosis.

Read more on B-lymphoblastic leukemia with hyperdiploidy (bone marrow – biopsy)…

Clinical history:

21 y/o male. WBC 3.9 HCT 35.4, PLT 46

Bone marrow aspirate:

Monomorphic B-lymphoblasts comprise the majority of cells.

Clinical history:

Female in her 60’s with pancytopenia and skin lesions. Bone marrow biopsy

Immunohistochemistry:

Clinical history:

56 year old man with weight loss and bleeding. WBC: 7,200 (10% blasts were identified at outside hospital).

Cytogenetics:

t(8;22) – This translocation involves the loci for MYC (8q24) and lambda light chain (22q11). It is less common in BL than the t(8;14), which involves the IGH locus.

Read more on Burkitt lymphoma (bone marrow – aspirate)…

Clinical history:

56 year old man with weight loss and bleeding. WBC: 7,200 (10% blasts were identified at outside hospital).

Immunohistochemistry:

Clinical history:

60 y/o female with WBC = 26

Bone marrow aspirate:

The majority of marrow cells are maturing or mature myeloids, with prominent populations of eosinopils and basophils also present.

Read more on Chronic myelogenous leukemia, chronic phase…

Clinical history:

42 year old man with fatigue, abdominal pain, and leukocytosis. WBC: 365,000. HCT: 18%. PLT: 568,000.

Cytogenetics:

t(9;22) – This translocation fuses portions of the genes BCR (22q11.2) and ABL (9q34), usually producing the p210 BCR-ABL fusion protein.

Read more on Chronic myelogenous leukemia, chronic phase (2)…

52 y/o female with diffuse lymphadenopathy, hepatosplenomegaly, and peripheral eosinophilia

29 y/o male with inguinal lymphadenopathy and peripheral eosinophilia

Clinical history:

38 y/o female with cervical and axillary lymphadenopathy

67 y/o female with mass in T9 vertebra

Clinical history:

5 y/o with a history of chemotherapy over the past year

Microscopic:

H&E – Small clusters of neuroblastoma cells can be a challenge to identify on routine histology.

Read more on Metastatic neuroblastoma…

Clinical history:

55 year old woman with anemia. WBC: 11,500. HCT: 26.2% PLT: 262,000.

Cytogenetics:

Isolated del(5q) – This cytogenetic abnormality defines MDS with isolated del(5q), and predicts responsiveness to lenalidomide.

Read more on Myelodysplastic syndrome with isolated del(5q) (Bone marrow – biopsy)…

52 y/o male with history of relapsed high-grade B cell lymphoma, undergoing salvage chemotherapy. Now has prolonged neutropenia. WBC: 2.7 (2% polys, 48% lymphs, 43% monos, 1% blasts), Hct 32%, Plt 115.

Read more on Myeloid left-shift, s/p GCSF therapy…

Clinical history:

50 y/o female with hepatosplenomegaly and abnormal circulating cells.

Clinical history:

60 year old woman with pancytopenia and splenomegaly. JAK2 mutation present.

Bone marrow aspirate stains:

21 y/o female with history of AML, 6 months post-allogeneic BMT, now with dropping counts: WBC 0.6, Hct 25.5%, Plt 25. (Feathered edge of bone marrow aspirate is best area, also circled area of touch prep.)

Read more on Residual/relapsing AML within a hypocellular marrow…

37 y/o male with urticaria. Bone marrow biopsy.