—  SPECIALTY CONFERENCE  —

Hematopathology
 Sunday, February 12, 2006 - 7:30 PM
Centennial I



Moderator:

John Cousar
University of Virginia Health System
Charlottesville, VA

Prior to this Annual Meeting, slides and case histories for this Specialty Conferences were posted below so they may be reviewed in advance. During the meeting, the slides and protocols were also available for study in the microscope room (Chicago B - F Room) for participants who wished to review them prior to the evening session.

Click here for the handout from this conference.


Click on each slide thumbnail image for an enlarged view
Case 1

Submitted by:
Kathryn Foucar
University of New Mexico
Albuquerque, NM

Clinical Summary:

This 53-year-old female with a 2-year history of neutropenia presents with an enlarged right axillary lymph node. Following lymph node biopsy, a bone marrow aspirate and biopsy were performed. The bone marrow was inaspirable.

CBC:   Differential count:
WBC 4,100/µL   Neutrophils 34%
RBC 4.2 x 106/µL   Lymphocytes 60%
Hgb 13.1 g/dL   Monocytes 2%
Hct 38%   Eosinophils 3%
MCV 91 fl   Basophils 1%
Plt 156,000/µL  



Case 1 - Figure 1
Low power photomicrograph of right axillary lymph node (H&E)
Case 1 - Figure 2
Intermediate power – right axillary lymph node (H&E)
Case 1 - Figure 3
High power medullary region of right axillary lymph node (H&E)


Case 1 - Figure 4
Peripheral blood smear (Wright's)
Case 1 - Figure 5
Low power photomicrograph of bone marrow core biopsy section (H&E)
Case 1 - Figure 6
Intermediate power photomicrograph of bone marrow core biopsy (H&E)


Case 1 - Figure 7
High power photomicrograph of bone marrow core biopsy section (H&E)
Case 1 - Figure 8
Bone marrow core biopsy (reticulin)




Case 2

Submitted by:
William G. Morice
Mayo Clinic
Rochester, MN

Clinical Summary:

The patient is a 67 year old male who presents with a 2 year history of a "myelodysplastic syndrome with refractory anemia". The patient had little improvement with either iron and vitamin B6 or erythropoietin therapies and he had been transfusion dependent for approximately one year. The patient had not received other treatments. His only complaint at the time of presentation was fatigue, which was alleviated with transfusion. He had not experienced problems with either recurrent infections or bleeding.

CBC values at the time of presentation were:
Hemoglobin: 8.3 g/dL, Erythrocytes: 2.89 x 10(12)/L, MCV: 84 fL, RDW: 14.7%
Reticulocytes: 0.5%
WBC: 9.6 x 10(9)/L, ANC: 0.8 x 10(9)/L, ALC: 8.6 x 10(9)/L
PLT: 461 x 10(9)/L

Bone marrow examination was performed to further evaluate for the possibility of myelodysplasia. Cytogenetic studies performed on the bone marrow aspirate revealed a normal male karyotype (46,XY) in 20 analyzed metaphases.


Case 2 - Figure 1
Peripheral blood smear
Case 2 - Figure 2
Bone marrow biopsy
Case 2 - Figure 3
CD3 (left) CD20 (right)


Case 2 - Figure 4
CD3 (left) granzyme B (right)
Case 2 - Figure 5
CD8
Case 2 - Figure 6
CD8


Case 2 - Figure 7
TIA-1 (top) granzyme B (bottom)



Case 3

Submitted by:
Vishnu V.B. Reddy
University of Alabama
Birmingham, AL

Clinical Summary:

This 73 year old female presented to family practice clinic in June of 2005 complaining increasing weakness and weight loss. A routine CBC showed anemia (Hgb 10.4 gm/dl), mild thrombocytopenia and mild leukocytosis (WBC 10.7 k/ul) with monocytosis (absolute monocyte count 2140 / cmm). Later, she was evaluated by hematologist and underwent bone marrow biopsy.


Case 3 - Figure 1
Bone marrow aspirate (Wight-Giemsa)
Case 3 - Figure 2
Bone marrow aspirate (Wight-Giemsa)
Case 3 - Figure 3
Bone marrow aspirate (Wight-Giemsa)


Case 3 - Figure 4
Bone marrow aspirate (Wight-Giemsa)
Case 3 - Figure 5
Bone marrow biopsy
Case 3 - Figure 6
Bone marrow biopsy


Case 3 - Figure 7
Immunohistochemical stain CD117 (c-kit)
Case 3 - Figure 8
Immunohistochemical stain CD117 (c-kit)
Case 3 - Figure 9
Immunochemical stain tryptase




Case 4

Submitted by:
James W. Vardiman
University of Chicago
Chicago, IL

Clinical Summary:

This 33-year old woman's chief complaint was gradually increasing fatigue for about one year. At the time she sought medical attention, the only significant physical finding was a "barely palpable" spleen. Laboratory data obtained demonstrated:

WBC=14.8 x 109/L, Hb=8.7g/dL, Platelets=1,247 x 109/L, Reticulocytes=4.3% with Reticulocyte Production Index=1.6.

A bone marrow biopsy and aspiration were performed, although the aspirate yielded only scant material.

Cytogenetic studies revealed a normal female karyotype. FISH studies showed no evidence of BCR/ABL fusion gene.

Additional laboratory studies included serum ferritin, 29ng/ml (normal range, 12-201), uric acid 7.5 mg/dL (normal range 2.0-7.5).

The blood and marrow findings were reported as "consistent with Essential Thrombocythemia (ET). The slides were referred to the University of Chicago for an additional opinion.


Case 4 - Figure 1
Case 4 - Figure 2
Case 4 - Figure 3


Case 4 - Figure 4
Case 4 - Figure 5
Case 4 - Figure 6


Case 4 - Figure 7
Case 4 - Figure 8