Hematopathology Cases
Case 1 Acute Promyelocytic Leukemia.
A 60 year old man presented with an absolute neutrophil count of 500, hemoglobin of 9.6 and a platelet count of 19,000.
Fig. 1 Bone marrow Biopsy, (100x) notice the extensive hypercellularity with immature cells.
Fig 2 Bone Marrow Aspirate (250x) notice immature promyelocytes.
Fig. 3 Bone Marrow Aspirate (450x) promyelocytic leukemia cell with Auer rod (arrow).
Fig 4 Cytogenetics show the 15:17 translocation typical of AML M3. He also presents a trisomy of chromosome #8 more commonly seen in myelodysplasias and other forms of AML.
Case 2 Metastatic Carcinoid to Bone Marrow
A 63 year old man presents with a three month history of diarrhea, 40 pound weight loss and ascites.
Fig 1 Bone Marrow Aspirate (200x) . Notice nests of tumor cells .
Fig 2 Bone Marrow Aspirate (400x) Cells consistent with metastatic carcinoid.
Fig 3 Bone Marrow Biopsy showing metastatic nests of carcinoid tumor. (arrow)
Fig 4 Bone Marrow Biopsy showing chromogranin-positive nests.(arrow)
Case 3 Megaloblastic Anemia
A 68 year old man presents with a history of cerebro-vascular accidents, coronary artery disease, peripheral vascular disease. While in the hospital, his hemoglobin fell from 12 gm/dl to 7 gm/dl .No evidence of GI bleed is noted. His labs showed increased ferritin and ESR. A BM biopsy was performed.
Fig 1 Peripheral blood smear. Notice hypersegmentation of neutrophils.
fig 2 Bone Marrow Aspirate. Notice immature, megaloblastic erithroid precursors.
Case 4 Hodgkin's Lymphoma
A 72 year old man presents with a history of fever and weight loss.
Fig 1 Bone Marrow Biopsy 100x, notice granuloma-like Hodgkin's infiltrate
Fig 2 Bone Marrow Biopsy 250x
Fig 3 Bone Marrow Biopsy 1000x . Notice Reed Sternberg-like cell
Fig 4 Mediastinal LN from autopsy 200x . Notice lymphocyte depletion.
Fig 5 Mediastinal LN from autopsy 450x
Fig 6 Mediastinal LN from autopsy 1000x Atypical, RS-like cell.
Fig 7 Electron micrograph of Reed Sternberg Cell
