2013 Annual Meeting

— SPECIALTY CONFERENCE HANDOUT —

Hematopathology

Monday, March 4, 2013, 7:30 PM
CC Ballroom 4

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Clinical histories are printed below.
Click on the case numbers for text and references of each case.
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Pediatric Hematopathology

Moderator:
ERIC HSI
Cleveland Clinic Foundation
Cleveland, OH
Disclosure:
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. Eric His has discloses that he is a consultant for Leica. The other speakers listed below have indicated they have nothing to disclose.
Panelists:
Robert P. Hasserjian, Massachusetts General Hospital, Boston, MA
Michele E. Paessler, Chldren's Hospital of Philadelphia, PA
John Kim Choi, St. Jude Children's Research Hospital, Memphis, TN
M. Kathryn Foucar, University of New Mexico, Albuquerque, NM

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Case 1 - Click here for Text and References

Submitted by: Robert P. Hasserjian

Clinical Summary:

14 year old boy with isolated right inguinal lymphadenopathy. 6.0 x 4.3 x 2.5 cm lymph node excised

Pertinent Laboratory Data:

PCR study on paraffin tissue showed a single, intense, discrete peak with IGH Vregion framework 1 and 2 primers, consistent with a clonal IGH rearrangement. No IGH-BCL2 rearrangement was detected by PCR. FISH study on paraffin tissue showed no IGH-BCL2 rearrangement.

Virtual Slide
Case 1 - Slide 1

Case 1 - Figure 1
H&E low
Case 1 - Figure 2
H&E medium
Case 1 - Figure 3
H&E high
Case 1 - Figure 4
CD21
Case 1 - Figure 5
BCL6
Case 1 - Figure 6
BCL2
Case 1 - Figure 7
CD3
Case 1 - Figure 8
Ki67

Case 2 - Click here for Text and References

Submitted by: Michele E. Paessler

Clinical Summary:

A 9 month old male with no previous medical history presents to the emergency room with a 2 week history of fever. Physical examination is significant for decreased breath sounds bilaterally. A CBC is significant for severe neutropenia. A bone marrow aspirate with flow cytometric analysis was performed.

CBC:

Component Result Range & Units
White Blood Cell Count 12.3 6.0 - 17.5 THOU/uL
Red Blood Cell Count 4.09 3.7 - 5.3 MIL/uL
Hemoglobin 10.1 (L) 10.5 - 13.5 g/dL
Hematocrit 30.1 (L) 33.0 - 39.0 %
Mean Corpuscular Volume 73.5 70.0 - 86.0 fL
Mean Corpuscular Hgb 24.6 23.0 - 31.0 pg
Mean Corpus Hgb Conc 33.5 30.0 - 36.0 g/dL
Red Distribution Width 16.9 (H) 11.5 - 14.5 %
Platelet Count 677 (H) 150 - 400 THOU/uL
Mean Platelet Volume 7.5 7.4 - 10.4 fL
Eosinophils 2 0 - 4 %
Lymphocytes 94 (H) 67 - 77 %
Monocytes 4 4 - 10 %
Total Cells Counted 100
Differential Method MANUAL
Anisocytosis 1+
Hypochromia 1+
Microcytosis 1+
Platelet Estimate INCREASED

Bone Marrow Aspirate:

Component Result Range & Units
Lymphoblasts 3.0 (H) 0 - 0 %
Lymphocytes 31.0 (L) 40.65 - 56.9 %
Plasmacytes 0.0 0.0 - 0.04 %
Monocytes 14.5 (H) 0.2 - 2.14 %
Histiocytes 0.0 %
Tumor Cells 0.0 0 - 0 %
Myeloblasts/Undifferentiated 1.0 (H) 0.0 - 0.92 %
Promyelocytes 10.0 (H) 0.07 - 1.33 %
Myelocytes 0.5 (L) 0.87 - 3.27 %
Metamyelocytes 0.0 (L) 7.9 - 15.7 %
Bands 0.5 (L) 9.55 - 18.61 %
Segmented Neutrophils 0.0 (L) 1.68 - 6.26 %
Eosinophils 11.5 (H) 0.66 - 2.82 %
Basophils 0.0 0.0 - 0.24 %
Proerythroblasts 2.5 (H) 0.0 - 0.16 %
Basophilic Normoblasts 1.5 (H) 0.07 - 0.55 %
Polychromic Normoblasts 10.5 4.34 - 11.12 %
Orthochromatic Normoblasts 13.5 (H) 0.0 - 0.87 %
Total Cells Counted 200.0
M:E Ratio 1:1.2 3:1-4:1
Megakaryocytes PRESENT
Bone Marrow Cellularity NORMAL
Flow Cytometric Analysis
Case 2 - Figure 1
GW(BMA 5x)
Case 2 - Figure 2
GW(BMA 20x)
Case 2 - Figure 3
GW(BMA 50x)
Case 2 - Figure 4
GW(BMA 50x)
Case 2 - Figure 5
GW(BMA 40x)
Case 2 - Figure 6
GW(BMA 40x)
Case 2 - Figure 7
FC
Case 2 - Figure 8
FC
Case 2 - Figure 9
FC
Case 2 - Figure 10
FC

Case 3 - Click here for Text and References

Submitted by: John Kim Choi

Clinical Summary:

22 month old previously healthy boy presented with 1 month history of fever, leukocytosis, anemia, thrombocytopenia, and excoriated generalized skin lesions. Physical exam showed generalized mild lymphadenopathy and splenomegaly. Bone marrow aspirate/biopsy and skin biopsy were performed.

Pertinent Laboratory Data:

CBC:

  • WBC x10e3/mm3 75.2 x10e3/mm3 (Ref. Range 7.3 - 16.6)
  • RBC x10e6/mm3 3.80 x10e6/mm3 (Ref. Range 4.10 - 5.30)
  • Hgb 11.0 g/dL (Ref. Range 11.3 - 14.1)
  • Hct 32.2 % (Ref. Range 33.0 - 41.0)
  • MCV 84.9 fL (Ref. Range 71.0 - 83.0)
  • RDW 17.9 % (Ref. Range 11.4 - 14.9)
  • Platelet Count 143 x10e3/mm3 (Ref. Range 200 - 550)
  • MPV 7.7 fL (Ref. Range 7.0 - 10.0)
  • Segs (%) 17 % (Ref. Range 9 - 47)
  • Bands (%) 1 % (Ref. Range 0 - 2)
  • Lymphocyte (%) 12 % (Ref. Range 43 - 79)
  • Monocyte (%) 66 % (Ref. Range 1 - 11)
  • Eosinophil (%) 1 % (Ref. Range 1 - 5)
  • Basophil (%) 0 % (Ref. Range 0 - 3)
  • Blast (%) Seen on scan (Ref. Range 0 - 0)
  • Promyelocyte (%) 1 % (Ref. Range 0 - 0)
  • Myelocyte (%) 1 % (Ref. Range 0 - 0)
  • Metamyelocyte (%) 1 % (Ref. Range 0 - 0)
  • NRBC 4 /100 WBC (Ref. Range 0 - 0)

Case 3 - Figure 1
GW (PBS 60x)
Case 3 - Figure 2
GW (BMA 60x)
Case 3 - Figure 3
HE (BMBX 4x)
Case 3 - Figure 4
HE (BMBX 60x)
Case 3 - Figure 5
CD117 (BMBX 60x)
Case 3 - Figure 6
MPO (BMBX 60x)
Case 3 - Figure 7
CD163 (BMBX 60x)
Case 3 - Figure 8
CD68_PG-M1 (BMBX 60x)
Case 3 - Figure 9
HE (SKIN 4x)
Case 3 - Figure 10
HE (SKIN 60x)

Case 4 - Click here for Text and References

Submitted by: M. Kathryn Foucar

Clinical Summary:

1. 16 year old male with hip pain for several months; 15- 20# weight loss and intermittent fever

2. Radiologic studies: multiple bony lesions involving skull, pelvis, ribs, scapula

3. BM examination performed

Pertinent Laboratory Data:

CBC: WBC 7.3 with normal neutrophil and lymphocyte counts
RBC 4.9
H/H 14.4/41%
MCV 84
RDW 12%
Plt 95

Case 4 - Figure 1
H&E, bone marrow core biopsy showing tumor giant cells and monotonous small neoplastic cells effacing bone marrow.
Case 4 - Figure 2
H&E, bone marrow core biopsy showing tumor giant cells and monotonous small neoplastic cells effacing bone marrow.
Case 4 - Figure 3
H&E, bone marrow core biopsy showing tumor giant cells and monotonous small neoplastic cells effacing bone marrow.
Case 4 - Figure 4
H&E, bone marrow core biopsy showing tumor giant cells and monotonous small neoplastic cells effacing bone marrow.
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