Pathology Conference
Corner
Hematology - Case #2
By: Jill Urban, MD and Kathleen Wilson, MD
Case Report
The patient, a 29 year old Hispanic male construction worker with
no significant previous medical history, presented with a 1 month
history of weakness and malaise. His most recent complaint was of
chest pain, dizziness and weakness after climbing 20 flights of
stairs. He also noted a 2 week history of easy bruising with a single
limited episode of epistaxis
His physical examination was remarkable for cervical and occipital
lymphadenopathy and a grade III/VI systolic ejection murmur. No
splenomegaly, petechiae or ecchymoses were seen.
Selected Laboratory Results:
|
Analyte
|
Value
|
Reference Range
|
|
Hemoglobin
|
6.4
gm/dl
|
13.5 - 18 g/dL
|
|
Hematocrit
|
18.0%
|
40-52% (Male)
|
|
MCV
|
91.9 fl
|
82-102 fL (Male)
|
|
MCH
|
32.4 pg
|
|
|
MCHC
|
35.2 g/dl
|
31-35 gm/dL
|
|
RDW
|
19.0 fL
|
35-47 fL
|
|
Platelets
|
5x103/µL
|
140-450x103/µL
|
|
MPV
|
9.6 fl
|
|
|
White Blood Cell Count (WBC)
|
42.0
mg/dl
|
4.1-10.9x103/µL
|
|
|
Diff
|
|
|
|
|
Polymorphonuclear Cells (Polys)
|
5%
|
35-80%
|
|
|
Immature Polys (Bands)
|
1%
|
0-10%
|
|
|
Lymphocytes (Lymphs)
|
10%
|
20-50%
|
|
|
Monocytes (Mono)
|
18%
|
2-12%
|
|
|
Eosinophils (Eos)
|
5%
|
0-7%
|
|
|
Basophils (Bas)
|
1%
|
0-2%
|
|
|
Atypical lymphs
|
4%
|
0%
|
|
|
Metamyelocytes
|
1%
|
0%
|
|
|
Blasts
|
55%
|
0%
|
A bone marrow aspirate and biopsy were performed.
Pathology
|
|
Peripheral Blood
Low Power
|
|
|
High Power
The peripheral smear shows pancytopenia with circulating
blasts.
|
|
|
Bone Marrow Aspirate
|
|
|
The aspirate shows 68% blasts and 26% eosinophils and
eosinophilic precursors. The erythroid precursors are
markedly decreased. Non-specific esterase stain (not shown)
revealed a spectrum of reactivity from negative to intensely
positive, with greater than 20% of the blasts showing
reactivity.
|
|
|
Trephine Biopsy
Low Power
|
|
|
High Power
The core shows hypercellularity with a diffuse leukemic
infiltrate.
|
Additional Studies
|
|
Cytogenetics
Idiogram
|
|
|
Inverse chromosome
The karyotype obtained from the bone marrow (not shown)
is 47, XY+8;inv(16)(p13.1q22). The inv(16) chromosome and
idiogram show the MYH11 and CBFß genes involved in the
inversion.
|
|
|
Flow Cytometry
Two populations are
identified.
|
RED 40%
of cells
|
GREEN
35% of cells
|
|
CD34(+)
|
CD34(dim to -)
|
|
CD13(+, not shown)
|
CD13(+)
|
|
CD33(+)
|
CD33(+)
|
|
CD64(partial+)
|
CD64(high +)
|
|
CD36(-)
|
CD36(+)
|
|
CD15(partial+)
|
CD15(+)
|
|
CD14(-)
|
CD14(+)
|
|
CD11b(-)
|
CD11b(partial +)
|
|
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Last modified: January 6, 1998