with flowcytometry, cytogenetic and molecular biology findings
Novartis IBA FM MU

Atypical chronic myeloid leukaemia (aCML), BCR-ABL1-negative

PB MGG (500×)

The white blood cell count shows leucocytosis (WBC >13×109/L) due to increased numbers of neutrophils and their precursors with prominent dysgranulopoiesis. This peripheral blood smear shows three myelocytes. Neutrophil precursors (promyelocytes, myelocytes, metamyelocytes) usually account for ≥10% of the leucocyte differential.

PB MGG (1000×)

This peripheral blood smear shows two granulocytes. One of them, the segmented neutrophil, has vacuolised cytoplasm and abnormally clumped chromatin (red arrow). The immature neutrophil cell is most likely a myelocyte with a pathologic nuclear-cytoplasmic ratio, representing another example of neoplastic cell (red arrow).

BM MGG (500×)

This bone marrow smear shows hypercellularity due to an increased number of granulocytic cells; the number of monocytic precursors could be increased in some cases, too (not seen it this particular case).  Erythroid dysplasia is clearly visible in this case; a binuclear late erythroblast with a nuclear bridge (green arrows) and another late erythroblast with atypical clumping of nuclear chromatin and with a Howell-Jolly body in cytoplasm (red arrow) are present in the smear.

BM MGG (1000×)

Marked clumping of nuclear chromatin in neutrophils and their precursors is one of the most typical morphologic abnormalities of the disease; however, it only occurs in some cases. This smear shows this abnormality in almost all of the neutrophils shown. However, atypical clumping of nuclear chromatin is also present in an intermediate erythroid precursor (red arrow).

BM MGG (1000×)

Dysgranulopoiesis is a constant finding at the disease, as shown in this image. Dyserythropoiesis is present in at least 50% of cases. This bone marrow smear shows one intermediate erythroblast with three nuclei (red arrow) and one late erythroblast with basophil stippling (green arrow) as examples of dysplastic changes in erythropoiesis.

BM MGG (1000×)

Megakaryocytes may be decreased, normal or increased in number, but some dysmegakaryopoiesis is present in most cases. There is a micromegakaryocyte shown in this image (red arrow). Abnormal nuclear chromatin clumping is present in the cells of granulocytic lineage.

Atlas of Haematological Cytology [online]. 2016 [cit. 2024-3-29]. Available from WWW: http://www.leukemia-cell.org/atlas.

2024 CELL - Atlas of Haematological Cytology | site map