Pathology Notes

Practice questions Myeloid neoplasms I © Jun Wang, MD, PhD 1. Use this case for the next two questions. A 51-year-old man presents with gum bleeding for 2 days. He has had purpura on his back and legs for the last two weeks. Physical examination reveals multiple petechiae on his oral mucosa, and multiple purpura measuring up to 3 cm in greatest dimension on his back and legs. No lymphadenopathy nor organomegaly are identified. Laboratory studies reveal a hemoglobin at 8.5 g/dL (normal 13-18g/dL), white cell count at 49 x 10 9 /L (normal 5-11 x 10 9 /L), platelet count at 7 x 10 9 /L (normal 150-450 x 10 9 /L). Peripheral blood smears reveal 25% of white cells are myeloblasts, monoblasts and promonocytes. Bone marrow aspiration and biopsy reveal large amount of blasts with similar morphology as those seen in peripheral blood. Eosinophil precursors with basophilic granules are seen. In addition, abnormal erythroid precursors with nuclear budding are seen. Karyotype analysis r

Practice questions answers Myeloid neoplasms I ©Jun Wang, MD, PhD 1. B. For acute myeloid leukemia , a diagnosis can be made with either >20% blasts, or confirmed recurrent genetic abnormalities. Acute lymphoblastic leukemia has LYMPHOBLAST, not myeloblast. Chronic myelogenous leukemia has less than 20% blasts and 9;22 translocation, Philadelphia chromosome, involving Abl and Bcr. Chronic myelomonocytic leukemia may have increased myeloblast, monocytes and monoblast, but the number of blasts is less than 20%, and inv(16)(p13.1;q22) is not seen in CMML. The presence of abnormal erythroid precursors are suggestive of myelodysplastic syndrome , however, by definition, if the quantity of blasts > 20%, or with confirmation of associated recurrent genetic abnormalities, the diagnosis is acute myeloid leukemia . 2. B. Abl is associated with chronic myelogenous leukemia , MTD 88 with lymphoplasmacytic lymphoma , RAR alpha with APL with PML-RARA , RUNX1-RUNX1T1 with AML

Hematology terms A Alder-Reilly anomaly :   Metachromatic granules surrounded by clear zone in lymphocytes, associated with the genetic mucopolysaccharidoses, due to lack the lysosomal enzymes necessary to break down mucopolysaccharides Amyloid : Amorphously deposited fibrillary protein, non-branching fibrils in a beta-pleated sheet conformation; can be monoclonal immunoglobulin; positive for Congo Red; suggestive of B cell disorder Anisocytosis : Red cells unequal in size , commonly seen in anemia Auer rod : N eedle shaped cytoplasmic azurophilic granular material, associated with APL with PML-RARA , and AML with t(8;21)(q22;q22.1) B Bence Jones proteins : Free light chains without attached heavy chains C Cloverleaf/flower cells : Neoplastic T cells with agranular basophilic cytoplasm, multilobated nuclei, in the appearance of clover leaf , seen in adult T cell leukemia/lymphoma Coombs test Direct : Detect antibodies/complements attached to surface of pat