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Acute promyelocytic leukaemia with PML-RARA

PB MGG (1000×)

One leukaemic promyelocyte (yellow arrow) showing a typical morphological finding: a bilobed (“angel-winged”) nucleus with very fine, blastic chromatin pattern and a large nucleolus; the cytoplasm is packed with fine and coarser azurophil granules.

PB MGG (1000×)

Three typical leukaemic promyelocytes (yellow arrows) showing a typical morphological finding: bilobed (“angel-winged”) nuclei with very fine, blastic chromatin pattern and large nucleoli; the cytoplasm is mostly filled with coarser azurophil granules.

PB MGG (1000×)

One leukaemic promyelocyte containing an oval-shaped nucleus with very fine chromatin and a nucleolus; the cytoplasm is packed with numerous coarser granules.

PB MGG (1000×)

Two leukaemic promyelocytes: one cell with a bilobed nucleus (left) and one cell with a folded nucleus, in a shape resembling an older cradle-style telephone receiver (right).

BM MGG (200×)

This hypercellular marrow aspirate smear shows a prevailing leukaemic population of promyelocytes. One megakaryocyte of a normal size, with normal lobulated nuclei and with hypogranular cytoplasm is seen in the upper part of the slide (cyan arrow).

BM MGG (1000×)

Many leukaemic promyelocytes with various shapes of nuclei and mostly with coarse and multiple granules. Granules in the leukaemic promyelocyte (bottom part of the image) almost cover its nucleus. The cells marked by white arrows are in more mature stages of granulopoiesis, with lower amounts of granules in some places. Four erythroblasts are seen in the left half of the image.

BM MGG (1000×)

This image of bone marrow aspirate smear shows many leukemic promyelocytes. The so-called faggot cells – leukaemic promyelocytes with numerous Auer rods resembling a bundle of sticks – are marked by yellow arrows. Two lymphocytes (green arrow) and one proerythroblast (black arrow) are also seen in this image.

BM MGG (1000×)

Leukaemic promyelocytes (many are shown in this image) are more prone to cytolysis. The so-called faggot cells – leukaemic promyelocytes with numerous Auer rods resembling a bundle of sticks – are marked by yellow arrows. One lymphocyte (green arrow), one activated plasma cell (white arrow) and one proerythroblast (black arrow) are also shown in this image.

BM MGG (1000×)

Leukaemic promyelocytes of various sizes with markedly coarse granules which cover the nuclei in several cells. Two lymphocytes (green arrows), one eosinophilic myelocyte (white arrow), two neutrophilic band cells (yellow arrows) and one erythroblast (black arrow) are also shown in this image.

BM MPO (1000×)

This bone marrow aspirate smear stained with myeloperoxidase shows many leukaemic promyelocytes with an excessive reaction (strongly positive cells). Two erythroblasts, which are always myeloperoxidase negative, are marked by black arrows.

Schematic representation of PML, RARA and PML-RARA genes

A. Genomic organisation of the PML loci. The red arrows indicate the three most common breakpoints in the PML gene:  between exons e3 and e4, within exon e6 and between exons e6 and e7.

B. Genomic organisation of the RARA loci. The blue arrow indicates a typical breakpoint in the RARA gene – between exons e2 and e3.

C. Schematic diagram of the three types of PML-RARA fusion genes. The black arrows mark junctions: i. bcr1 – behind exon e6 of the PML gene and in front of exon e3 of the RARA gene; ii. bcr2 – within exon e6 of the PML gene and in front of exon e3 of the RARA gene; iii. bcr3 – behind exon e3 of the PML gene and in front of exon e3 of the RARA gene.

G-banded female karyotype with t(15;17)(q22;q21)

G-banded karyotype 46,XX,t(15;17)(q22;q21) of a bone marrow metaphase cell from a patient with acute promyelocytic leukaemia (APL). Derivative chromosomes 15 and 17 are indicated by red arrows.

G-banded partial karyotype of t(15;17)(q22;q21)

G-banded partial karyotype demonstrating the translocation t(15;17)(q22;q21). Red arrows indicate derivative chromosomes 15 and 17. Breakpoint sites are indicated by black arrows on normal chromosome homologues.

Fluorescence in situ hybridisation (FISH) of t(15;17)(q22;q21)

Fluorescence in situ hybridisation (FISH) of the PML-RARα fusion performed on (A) metaphase chromosomes and (B) an interphase cell [a dual-colour, dual-fusion FISH probe was used]. Red arrows indicate the chromosomal region 15q22, where the PML gene is located, whereas the green arrows indicate the chromosomal region 17q21, where the RARα gene is located. Yellow arrows indicate the PML-RARα fusion (red-green signal) on a derivative chromosome 15 and RARα-PML on a derivative chromosome 17 (A) and the same fusions on interphase cells (B).

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

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