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Hematopathology
Wednesday, March 21, 2012, 7:30 PM
Convention Centre 211-214
Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view
Leaving Lymphomas: Loving Leukemias and Making-Out with Myeloid Malignancies
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Moderator:
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ADAM BAGG
Univ of Pennsylvania
Philadelphia, PA
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Disclosure:
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In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose.
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Panelists:
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Daniel A. Arber, Stanford Univ Med Ctr, Stanford, CA
Sa Wang, UT MD Anderson Cancer Ctr, Houston, TX
Attilio Orazi, Weill Medical Coll/Cornell Univ, New York, NY
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Clinical histories are displayed below.
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for Text and References
Submitted by: Daniel A. Arber - Stanford Univ Med Ctr, Stanford, CA
This 48 year old woman presented to her primary care physician with complaints of fatigue. A CBC was performed with the following results: WBC: 10.5 K/uL HGB: 8.9 g/dL HCT: 25.9 % MCV: 91.1 fL PLT: 203 K/uL RDW: 20.1 %. Review of the peripheral blood smear showed 79% blasts. She was referred to a hematologist for bone marrow examination. Submitted is a bone marrow aspirate smear and trephine biopsy.
Case 1 - Slide 1
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Case 1 - Slide 2
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for Text and References
Submitted by: Sa Wang - UT MD Anderson Cancer Ctr, Houston, TX
An 84-year-old-woman, with a history of an artificial heart valve, noticed significant fatigue and paleness in May 2009. She received red cell transfusion, and a bone marrow (BM) biopsy and aspirate (not shown) was performed. A CBC at the time of BM biopsy showed: WBC: 2.3 (70% neutrophils, 28% lymphocytes and 2% monocytes); Hb: 6.8 (MCV 92); Platelets: 32. A diagnosis of refractory cytopenia with multilineage dysplasia was made. She received 5-azacitidine from September 2009 to July 2010 with an initially significant improvement in transfusion dependency. In August 2011, her counts deteriorated. A CBC at this visit showed: WBC: 0.6 (12.5% neutrophils, 82.5% lymphocytes and 5% eosinophils); Hb: 7.1 (MCV 94); Platelets: 19. Another bone marrow was performed.
for Text and References
Submitted by: Attilio Orazi - Weill Medical Coll/Cornell Univ, New York, NY
35 year old man History of mild thrombocytosis for few years To investigate the possibility of MPN, referred to WCMC/NYPH in November 2007. No splenomegaly/organomegaly.
CBC(11/1/07)showed: Hb 13.1 g/dL Hct 39.5 % MCV 80.5 fL WBC 6.5 x109/L (N, 68; Ly 18; Mo 11; Eo 2, Ba 1) Plts. 483 x109/L P.B. smears (not available) showed only mild anisopoikilocytosis and thrombocytosis. Other results: LDH 248 U/L ( 96-200 U/L) JAK2V617F mutation present Red Cell Mass within normal range EPO normal Flow cytometry unremarkable Normal karyotype BCR-ABL1 absent (FISH) TCR gamma and IgH chain gene(PCR) negative
Case 3 - Slide 1
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Case 3 - Figure 1
Hypercellular bone marrow with an increased number of megakaryocytes. Note their pleomorphism with wide variation in both size and nuclear morphology. |
Case 3 - Figure 2
Pleomorphic megakaryocytes forming clusters. Some of the cells display abnormalchromatin clumping and/or hyperchromatic nuclei. Note the increased granulopoiesis. |
Case 3 - Figure 3
Higher magnification showing findings similar to those seen in figure 2. |
Case 3 - Figure 4
Lymphoid aggregates are identified. These are composed of small lymphocytes. A large lymphoid aggregate corresponding to a reactive lymphoid follicle with an identifiable germinal center is also noted. |
Case 3 - Figure 5
Immunohistochemistry for CD3. The antigen is found expressed in many small lymphocytes. |
Case 3 - Figure 6
Immunohistochemistry for CD20. A proportion of small lymphocytes express CD20. |
Case 3 - Figure 7
Touch preparation showing predominantly maturing myeloid cells and granulocytes. |
Case 3 - Figure 8
Reticulin stain showing MF-0 to MF-1 (Manoharan/Baumeister grade 1 to 2) Additional images: |
Case 3 - Figure 9
Follow-up bone marrow biopsy performed in the Fall of 2011 showing increased cellularity and more pronounced megakaryocytic atypia associated with myelofibrosis (see reticulin and trichrome stains shown below)consistent with progression to overt fibrotic stage of PMF |
Case 3 - Figure 10
Follow up bone marrow biopsy showing several tight cluster of highly atypical megakaryocytes |
Case 3 - Figure 11
Follow up bone marrow biopsy. Reticulin stain shows MF-2 fibrosis (Manoharan/Baumeister grade 3) |
Case 3 - Figure 12
Follow up bone marrow biopsy. Trichrome stain shows traces of collagen. |
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