Hematology 2000
© 2000 The American Society of Hematology
Morphology Glossary
James R. McArthur, M.D.*
*
Professor Emeritus, University of Washington School of Medicine, Department of
Hematology, 5736 64th NE, Seattle WA 98105
In this morphology "glossary" are found examples of many of the
items discussed in the body of this book. The collection was originally
assembled for the Interamerican Division Regional Update in Leukemia course in
Puebla, Mexico (Dr. G.J. Ruiz-Argüelles and Dr.
E. Torré-Lopez). It has subsequently been used
in Ankara, Turkey (Dr. E. Kansu) and Cordoba, Argentina (Dr. C. Ponzinibbio).
Developments in informatics have enabled the cost-effective reproduction of
these images.
The glossary has been rearranged and enlarged since its ASH Education
Program introduction—principally with slides used in the Morphology
Panel of the ISH Amsterdam congress (Drs. Bain, Brunning, Castoldi, Kluin,
Matutes, McArthur, den Ottolander, and Verhoef). It is now divided into four
major sections: lymphoid, myeloid, megakaryocytic, and erythroid.
Unless otherwise stated, oil magnification of Wright's-stained smears are
shown.
Normal and Abnormal Lymphoid Cells
Slide L1
A normal peripheral blood lymphocyte and
monocyte.
Slide L2
A normal, nonmalignant, reactive lymph node. Follicular hyperplasia is
seen, both in the central and cortical areas. Very low power view, hematoxylin
and eosin (H&E) stain.
Slide L3
Normal spleen. The vascular structures, sinusoids, and intervening lymphoid
areas can be appreciated. Very low power view, H&E
stain.
Slide L4
The azure granules of the Alder-Reilly-Day anomaly, peripheral
blood.
Slide L5
Infectious mononucleosis, peripheral blood. These reactive atypical
lymphocytes have pleomorphic reticular nuclei, peripheral basophilia of
cytoplasm, and scalloped cell borders, some of which appears to stream into
red cells.
Slide L6
Acute lymphoblastic leukemia, FAB classification L1, bone marrow aspirate.
The appearance of these blasts—very fine nuclear chromatin, nucleoli, and the
high nuclear to cytoplasmic ratio is characteristic of this
diagnosis.
Slide L7
Acute lymphoblastic leukemia, FAB classification L2, peripheral blood. Five
blasts surround a lymphocyte. These blasts are somewhat large and have a
varied morphology. They can sometimes be confused with myeloid or monocytic
cells.
Slide L8
Philadelphia chromosome-positive acute lymphoblastic leukemia. These blasts
have a relatively high nuclear-cytoplasmic ratio and moderately condensed
chromatin. They were CD19, CD10, and TdT
positive.
Slide L9
Acute lymphoblastic leukemia, FAB classification L3, bone marrow aspirate.
The variation in size and shape of the cells and their nuclei, as well as the
presence of cytoplasmic and nuclear vacuoles are characteristic of this
diagnosis.
Slide L10
Acute lymphoblastic leukemia, FAB classification L2, bone marrow aspirate,
periodic acid-Schiff stain (PAS). The coarse granularity in the cytoplasm as
well as some frank cytoplasmic globules are characteristic of the PAS reaction
when it is positive in
lymphoblasts.
Slide L11
Biphenotypic (mixed lineage) acute leukemia, bone marrow aspirate, adult.
There is a mixture of blasts, some displaying lymphoid features while others
are larger, undifferentiated with features suggestive of acute myeloid
leukemia. Immunological markers demonstrated that the majority of blasts from
this adult patient coexpressed B-lymphoid (CD79a, cytoplasmic CD22, CD10) and
myeloid (CD13, CD33, myeloperoxidase) antigens and were positive for early
hematopoietic associated markers (CD34, HLA-DR and TdT). Morphology of
biphenotypic acute leukemia (BAL) is variable with some cases resembling acute
lymphoblastic leukemia and others resembling one of the subtypes of acute
myeloid leukemia. It is not unusual to find two morphologically distinct blast
populations (E. Matutes, Haematologica 82:4, 1997). Immunophenotyping is a key
diagnostic test for BAL since its recognition has important prognostic
implications.
Slide L12
Chronic lymphocytic and acute myeloblastic leukemia, simultaneously at
presentation, bone marrow aspirate. This 75-year-old man, presenting with
enlarged lymph nodes and hepatosplenomegaly, had been desperately ill for
several days with severe anemia, thrombocytopenia and spontaneous tumor lysis.
Bone marrow smears show a mixture of small cells with clumped nuclear
chromatin and scanty cytoplasm, and larger cells with finely dispersed nuclear
chromatin and basophilic cytoplasm with vacuolization. A presumed diagnosis of
CLL with Richter's transformation was made. Immunophenotype of the small cells
confirmed the CLL population (dim surface immunoglobulin, positive for CD5, CD
19 and CD23 and negative for FMC7 and CD22). However, immunophenotype of the
larger blast cells could not confirm a lymphoid origin. The large cells were
negative for lymphoid markers and, surprisingly, were positive for HLA-DR,
CD33, CD15 and cytoplasmic myeloperoxidase (cyMPO), compatible with blast
cells of myeloid origin.
Slide L13
B cell chronic lymphocytic leukemia with more than 10% prolymphocytes,
CLL/PL. (See Noell et al. Br J Haematol 63:377, 1986.) Typically, this
abnormality shows two cell populations. There is one large population of small
CLL lymphocytes. The second, smaller population is of large, nucleolated
prolymphocytes. In this case, the latter are represented by a large cell with
two nucleoli, which almost resembles a blast. Also, note a smudge cell in the
photograph and the typical nuclear chromatin pattern of the CLL
lymphocytes.
Slide L14
Prolymphocytic leukemia (PLL). This composite slide shows prolymphocytic
leukemia (PLL) from two different patients. On the left is B cell PLL and on
the right, T cell PLL. The B-PLL cells correspond to the classic description
of Galton et al. (Br J Haematol 27:7, 1974): They are larger than CLL
lymphocytes, have condensed chromatin, and have prominent large nucleoli. The
T-PLL cells have a less conspicuous nucleolus, an irregular nuclear outline,
and cytoplasmic blebs, as described by Matutes et al. (Blood 78:12, 1991). In
many cases it may (FIX) be difficult to distinguish B-PLL from T-PLL cells on
morphologic grounds alone, without performing additional immunophenotypic
studies.
Slide L15
This composite view shows B chronic lymphocytic leukemia on the left and T
chronic lymphocytic leukemia on the right, peripheral blood. In this instance
one cannot discern a great deal of difference between the lymphocytes.
However, two destroyed cells, characteristic of B cell CLL, are seen on the
left.
Slide L16
Sézary's syndrome, buffy coat preparation.
The nuclear pleomorphism and convolutions are prominent with many cells
showing the frank cerebriform appearance of
Sézary
cells.
Slide L17
Hairy cell leukemia. The cytoplasmic strands and the very reticular
appearance of the nuclear chromatin are
characteristic.
Slide L18
Hairy cell leukemia, variant (HCL-V), peripheral blood. Cells are medium to
large in size and have an abundant villous cytoplasm and a prominent single
nucleolus. Thus, the nuclear features are similar to those of prolymphocytes
while the cytoplasm resembles that of hairy cells. (Sainati et al. Blood
76:157, 1990). The patient presented with splenomegaly and a high white cell
count, and was not monocytopenic. Immunological markers demonstrated the
B-cell nature of the cells with light chain restriction (lambda+, kappa-),
CD19+, FMC7+ with strong expression of CD11c and CD103 (two markers positive
in typical HCL). However, the cells did not express two other typical hairy
cell antigens, CD25 and HC2. The differential diagnosis includes typical HCL,
prolymphocytic leukemia and splenic lymphoma with villous lymphocytes. Cell
morphology and immunological markers are useful to distinguish between typical
HCL and its variant form while morphology and histology helps to distinguish
HCL variant from the splenic lymphoma with villous lymphocytes and
prolymphocytic leukemia.
Slide L19
Splenic lymphoma with circulating villous lymphocytes (SLVL). There are
four lymphoid cells of medium to small size, with condensed nuclear chromatin,
nucleolus, basophilic cytoplasm, and irregular projections at the end of the
cell. The differential diagnosis includes HCL and HCL variant. The SLVL cells
have a higher nuclear to cytoplasmic ratio and are smaller in size. In
contrast to CLL, SLVL cells have irregular and slightly more abundant
cytoplasm. Compared to B-PLL, SLVL cells have more condensed chromatin and
prominent villi. (Mulligan and Catovsky, Leukemia and Lymphoma 6:97,
1992)
Slide L20
Marginal zone lymphoma (?), peripheral blood. This 75-year-old man had
slight splenomegaly, no lymphadenopathy, and a history of increasing
lymphocytosis over the prior 4 years. The Hb was 8.0 g/dL, WBC 45 x
109/L, and platelets 183 x 109/L. The lymphocytes
were C19+, CD20+, CD22+, CD5-, CD11c weakly positive, CD25-, and light chain
restricted.
Slide L21
CLL with Richter's transformation, peripheral blood. This 47-year-old male
presented with an abdominal mass and hepatosplenomegaly. There are a mixture
of small cells with clumped nuclear chromatin and scanty cytoplasm, and large
cells with fine nuclear chromatin and more abundant basophilic cytoplasm.
Immunophenotype showed a marker profile typical of CLL: dim surface
immunoglobulin, positive for CD5 and CD23, negative for FMC7 and CD22.
Cytogenetic analysis revealed a complex
karyotype.
Slide L22
Hodgkin's disease, bone marrow aspirate. A classic binucleate
Reed-Sternberg cell is seen in the center of the field, a rare finding in a
bone marrow aspirate. The nuclei are mirror image, the nucleoli are large and
there is intense cellular basophilia as well as marked cytoplasmic
vacuolization.
Slide L23
Mononuclear Hodgkin's cell, bone marrow
aspirate.
Slide L24
Hodgkin's disease. H&E stained bone marrow biopsy. A classical
binucleate Reed-Sternberg cell is seen in the center of the field. The
surrounding cellular infiltrate is interspersed with some fibrous tissue and
other stroma.
Slide L25
Hodgkin's disease, H&E stained bone marrow biopsy. Complete replacement
of the normal bone marrow elements is noted. The process contains both
cellular elements and
fibrosis.
Slide L26
Hodgkin's disease, mixed cellularity (HDMC), lymph node. A binucleate
Reed-Sternberg cell is seen near the center of the field. There is some
fibrosis. Lymphocytes, plasma cells, and eosinophils can also be
appreciated.
Slide L27
Nodular sclerosing Hodgkin's disease (HDNS), H&E stain. Hodgkin's
cells, lacunar cells, lymphoid, and histiocytic cells are all seen in this
slide.
Slide L28
Reactive plasmacytosis with circulating plasma cells. Composite: blood (L)
and bone marrow (R). This 71-year-old male was admitted because of fever
(38.3°C) and suspected cholangitis. The WBC was 15.4 x
109/L with 10% plasma cells. A bone marrow aspirate showed about
30% small plasma cells with deep blue cytoplasm. A diagnosis of multiple
myeloma with circulating plasma cells was considered. The total protein was
not increased. The gamma globulin fraction was 40%. Agar electrophoresis
revealed several monoclonal components. In the immunoelectrophoresis, the
major component appeared to be a IgM-kappa paraprotein. The normal
immunoglobulins were not decreased. Immunophenotyping of the blood plasma
cells proved the polyclonality of these cells with a kappa/lambda ratio of
55/45. After treatment of the infection, plasma cells disappeared from the
blood.
Slide L29
Polyclonal B cell lymphocytosis. Composite slide of a peripheral blood film
from a 48-year-old asymptomatic woman with polyclonal B-cell lymphocytosis.
The cells are large, twice the size of a normal lymphocyte and have abundant
pale cytoplasm and mature non-condensed chromatin. Some cells show a bi-lobed
and/or deeply indented nucleus. Immunophenotype showed a polyclonal B-cell
population FMC7+, CD19+, CD22+, CD5- with 40% lymphocytes staining with
anti-lambda and 30% with anti-kappa. Cytogenetics and molecular analysis
confirmed the polyclonal nature of the cells. Differential diagnosis includes
"spill over" of B-cell non-Hodgkin's lymphoma cells into the
peripheral blood.
Slide L30
Circulating follicular NHL lymphoma cells. This is a peripheral blood smear
from a patient with follicular lymphoma showing three lymphoma cells and a
normal large granular lymphocyte. The last, in the center of the field, has
abundant clear cytoplasm and fine granules. The three follicular lymphoma
cells have deep clefts, small size (slightly larger than erythrocytes), and a
homogeneously stained nuclear chromatin without nucleoli. This appearance
differs from that of a CLL cell. These cells also have a lack of visible
cytoplasm.
Slide L31
Mantle cell lymphoma, peripheral blood. The picture is pleomorphic with a
predominant medium sized lymphoid population having nuclei with dense but not
clumped chromatin, occasional nuclear clefts, and a single small nucleoli.
Immunophenotype showed a clonal B-cell population with strong expression of
surface immunoglobulins and membrane CD22. The cells were positive for FMC7
and CD5, and negative for CD23. This profile differs from B-cell chronic
lymphocytic leukemia, which typically shows dim surface immunoglobulin and
CD23 positivity. Cytogenetic analysis revealed a t(11:14)(q13;q32), and spleen
histology showed diffuse involvement by medium size lymphocytes with a cleaved
nucleus, confirming the diagnosis of mantle-cell lymphoma in this 66-year-old
man.
Slide L32
Post-transplant B cell lymphoma, peripheral blood. This 38-year-old man was
156 days post unrelated donor bone marrow transplant for chronic myeloid
leukemia and was being treated with cyclosporin A. Immunophenotyping of the
plasmacytic-lymphocytic cells in the blood showed an IgG kappa light chain
restricted population. Molecular studies revealed immunoglobulin heavy chain
gene rearrangement. The patient expired two days
later.
Slide L33
"Adult" T cell leukemia lymphoma (ATLL). Peripheral blood film
from a 38-year-old black Caribbean patient. The lymphocytes are small to
medium size and display a highly irregular nucleus with an inconspicuous
nucleolus and multiple indentations; for this reason they are often designated
"flower cells." Immunophenotype showed the mature, activated
helper T cell nature of the cells (TdT-, CD1a-, CD2+, CD3+, CD5+, CD7-) with a
CD4+, CD8-, CD25+ phenotype. Antibodies to the human T-cell leukemia/lymphoma
virus (HTLV-1) were detected in the patient's serum, and molecular analysis of
the tumor cells showed a clonal integration of the proviral HTLV-1 in the
cells' DNA.
Slide L34
Anaplastic large cell non-Hodgkin's lymphoma. Peripheral blood film from a
52-year-old man with large-cell lymphoma evolving into leukemia. The cells are
large (>3 times the size of a red blood cell) and have reticular chromatin,
deeply basophilic cytoplasm, and one to three nucleoli. The mature B lymphoid
nature of the cells was confirmed by immunological analysis that showed a
clonal B cell population positive for kappa, CD19, and FMC7 and negative for
lambda, CD5, CD23, and
CD2.
Slide L35
Burkitt's lymphoma. Composite: bone marrow biopsy (L) and bone marrow
aspirate (R). Giemsa stained. This 19-year-old male presented with a
submandibular tumor in 1997. A biopsy revealed non-Hodgkin's lymphoma,
Burkitt's type, according to the REAL classification. Staging revealed stage I
disease. He was treated with aggressive polychemotherapy for Burkitt's
lymphoma and an allogeneic bone marrow transplant was planned for March 1998.
Two weeks before BMT, the patient complained of back pain, and there was a
sharp rise of LDH. A bone marrow smear and biopsy revealed massive
infiltration by Burkitt lymphoma blasts. Few tumor cells were seen in the
blood smear. The slide (R) shows typical Burkitt's lymphoma with vacuolated
cytoplasm (ALL-L3 blasts according to the FAB classification). The bone marrow
biopsy (L) also shows the typical, leukemia type, interstitial infiltration,
leaving the fat cells
intact.
Slide L36
Anaplastic large cell lymphoma. Lymph node aspirate (R) and tumor biopsy
(L). A 10-year-old boy presented with a large intra-osseous tumor in the
proximal tibia and enlargement of a supraclavicular lymph node. Aspiration
cytology of the lymph node (R) showed medium-sized "plasmacytoid"
cells with eccentric nuclei. Some cells showed cytoplasmic extensions
simulating sarcoma. One cell in the slide shows a small "nuclear
window." A trephine biopsy of the tumor of the tibia (L; H&E) showed
a tumor rich in histiocytes. Tumor cells were vimentin, CD30, ALK-1 positive,
and weakly CD45RO positive. This is a typical example of a peripheral T cell
lymphoma, according to the REAL classification, anaplastic large cell lymphoma
(ALCL), (lymphohistiocytic) variant. The ALK-1 positivity suggests a variant
translocation t(2;5) since the staining was mainly cytoplasmic (not shown).
Tumor cells can be relatively small in this variant of ALCL and may resemble
large plasma cells. Bone involvement is relatively common in
ALCL.
Slide L37
Anaplastic (Ki-1+) T cell lymphoma, bone marrow smear from an adult
patient. The cells are very large, up to ten times the size of a normal
lymphocyte and have a nucleus with reticular chromatin and basophilic
vacuolated cytoplasm. Immunophenotyping demonstrated the T-cell nature of the
cells (CD3+) with expression of CD30 (Ki-1). Most anaplastic Ki-1+ lymphomas
are of T-cell origin, characteristically express the Ki-1 antigen and are
associated to the t(2;5). BM involvement in anaplastic large cell lymphoma is
rare and the presence of these large cells in the bone marrow aspirates is
even less frequent. Differential diagnosis includes Hodgkin's disease and
non-hemopoietic tumors. Histology and immunological markers are key tests for
the diagnosis.
Slide L38
T cell large granular lymphocyte leukemia (T-LGL). Peripheral blood smear
shows typical LGLs with intracytoplasmic granules. Photo courtesy of Bruce
Cheson, MD.
Slide L39
Multiple myeloma, bone marrow aspirate. Virtually every cell in the field
is a neoplastic plasma cell. They show nuclear eccentricity, pleomorphism, and
a tendency to stick together in
clumps.
Slide L40
Multiple myeloma, bone marrow aspirate. The marrow has been completely
replaced by abnormal plasma cells. A binucleate plasma cell is seen in the
center of the field.
Slide L41
Multiple myeloma, bone marrow aspirate. The cytoplasmic periphery of these
cells has a much more intense pink stain, therefore the names flaming myeloma
cells or flaming plasma
cells.
Slide L42
IgA myeloma, bone marrow biopsy. Several of the plasma cells contain
intranuclear inclusions referred to a Dutcher bodies. These structures are
found in a wide spectrum of immunoproliferative disorders and had been most
frequently associated with plasmcytoid lymphomas. They lack specificity for
any subtype of the immunoproliferative
processes.
Slide L43
Multiple myeloma, bone marrow aspirate. There are binucleate myeloma cells
with granules. This patient had a chronic reactive plasmacytosis and adult
Fanconi syndrome for many years prior to having dissemination of the myeloma.
The needle-like cytoplasmic inclusions in the plasma cells were also found in
the renal tubular cells.
Slide L44
Multiple myeloma, bone marrow biopsy, Giemsa stain. There is complete
replacement of the normal marrow by neoplastic plasma cells. These again are
recognized primarily by their nuclear
eccentricity.
Slide L45
Waldenström's macroglobulinemia, peripheral
blood. There are abundant plasmacytoid lymphocytes and a suggestion of
rouleaux formation.
Slide L46
Lymphoplasmacytic lymphoma associated with IgM monoclonal gammopathy, bone
marrow biopsy. The marrow is extensively replaced by small lymphocytes,
plasmacytoid lymphocytes, and plasma cells. The process is interpreted as
marrow involvement by a plasmacytoid
tumor.
Slide L47
Plasma cell leukemia, peripheral blood. Five neoplastic plasma cells are
seen, one of which is binucleate. Slight rouleaux formation of some red blood
cells is seen.
Slide L48
Amyloid, bone marrow biopsy, H&E stain. A small blood vessel is heavily
infiltrated with the pink-staining, waxy amyloid
material.
Slide L49
HIV-associated lymphadenopathy, lymph node, H&E. Multinucleated cells
are clearly appreciated, as is a
venule.
Slide L50
Kaposi sarcoma, lymph node section, H&E. This lymph node from a patient
with AIDS has been virtually completely infiltrated with Kaposi
sarcoma.
Slide L51
Leishmaniasis associated with AIDS, bone marrow biopsy. Leishmania
donovani are noted in macrophages. These parasites are similar in size to
Histoplasma capsulatum, but the "double dot" appearance
of the nucleus and kinetoplast is apparent in Leishmania (see
center).
Slide L52
Striking dysgranulopoiesis associated with AIDS, bone marrow aspirate,
May-Gruenwald-Giemsa. One of the macropolycytes is likely to be tetraploid (92
chromosomes) and the other to have 138 chromosomes. A normal neutrophil is
shown in the lower left for
comparison.
Slide L53
Hodgkin's disease associated with AIDS, bone marrow biopsy, H&E. Total
replacement of normal bone marrow by an abnormal infiltrate including two
Reed-Sternberg cells (top
right).
Normal and Abnormal Myeloid Cells
Slide M1
Normal lymphocyte and
neutrophil.
Slide M2
Normal bone marrow cells. Five erythroid precursors (with pyknotic nuclei)
are present. The remaining cells are myeloid precursors in varying stages of
maturation ranging from myeloblasts to segmented
neutrophil.
Slide M3
Low-power view of an H&E stained normal bone marrow biopsy. Normal
distribution and cellularity are seen. Several distinct megakaryocytes can be
recognized because of their large size and multiple nuclear
lobes.
Slide M4
Neutrophilia. Four segmented and two band neutrophils are seen in this
low-oil magnification view of the peripheral blood. Some red blood cells are
slightly hypochromic.
Slide M5
May-Hegglin anomaly, peripheral blood. Giant platelets and spindle-shaped
Döhle bodies are
seen.
Slide M6
A normal eosinophil and red blood
cells.
Slide M7
Undifferentiated acute leukemia, peripheral blood. Three blasts are seen in
the center of the field and a somewhat abnormal neutrophil is seen
peripherally.
Slide M8
Acute nonlymphoblastic leukemia, FAB classification M0, bone marrow
aspirate from a 69-year-old man. The blasts are small or medium sized with no
visible cytoplasmic granules, and few are nucleolated. The myeloperoxidase and
nonspecific esterase reactions were negative. The myeloid nature of the blasts
was documented by (1) immunophenotype expression of CD13, CD33, positive
reaction with a monoclonal antibody against myeloperoxidase (anti-MPO), and
negative lymphoid markers; and (2) ultrastructural cytochemistry, which
demonstrated peroxidase activity localized in small
granules.
Slide M9
Acute nonlymphoblastic leukemia, FAB classification M1, bone marrow
aspirate. Virtually all of the cells in the bone marrow were myeloblasts.
There was little evidence of maturation beyond the myeloblast stage. Several
myeloblasts contain azurophilic granules, and occasional Auer rods are
identified.
Slide M10
Acute nonlymphoblastic leukemia, FAB classification M2, bone marrow
aspirate. The blast cells in this marrow contain abundant azurophilic
granulation. Numerous long, slender Auer rods are also illustrated in this
field. These findings are suggestive of the t(8;21) chromosome
abnormality.
Slide M11
Translocation (8;21). This karyotype is from the patient with M2 acute
nonlymphoblastic leukemia whose bone marrow is seen in
M10.
Slide M12
Hypogranular acute promyelocytic leukemia, FAB classification M3, bone
marrow aspirate. The myeloblast in the central portion of the photograph
contains numerous Auer rods. This cell is referred to as a faggot cell and is
found in approximately 90-95% of patients with acute promyelocytic
leukemia.
Slide M13
Translocation (15;17) characteristic of M3 acute
leukemia.
Slide M14
Acute nonlymphoblastic leukemia, FAB classification M4, bone marrow
aspirate. The large abnormal blast on the left has distinct monocytoid
features, some membrane irregularity, and some cytoplasmic vacuoles as well as
gray-blue cytoplasm. The two blasts on the right have very immature nuclear
chromatin, nucleoli, and some cellular granules. They are clearly myeloid
rather than monocytoid. Thus this field illustrates the two lineages that are
characteristic of M4 acute
leukemia.
Slide M15
Acute nonlymphoblastic leukemia, FAB classification M4Eo, bone marrow. It
is associated with an inversion of the long arm of chromosome 16. In addition
to the promonocytes and early forms, there are many abnormal eosinophils, some
of which have coarse basophilic
granules.
Slide M16
Acute nonlymphoblastic leukemia, FAB classification M5a (L) and M5b (R).
The M5a blasts have a moderate amount of cytoplasm and somewhat coarse nuclei.
The nucleoli are not unusually prominent. The blasts were positive with the
nonspecific esterase stain, and the patient had an associated t(9;11)
chromosome abnormality.
The predominant M5b cell is a promonocyte. This cell is characterized by
abundant cytoplasm with numerous scattered azurophilic granules and a nucleus
with finely dispersed nuclear chromatin. The nuclei are marked by extensive
lobulation and creasing. Some of the nuclei have a cerebriform
appearance.
Slide M17
Acute nonlymphoblastic leukemia (ANLL), FAB classification M5 with
erythrophagocytosis, bone marrow aspirate. This morphological entity is
associated with a specific reciprocal translocation that involves the short
arms of chromosome
t(8;16)(p11;p13).
Slide M18
Acute nonlymphoblastic leukemia, FAB classification M6, bone marrow
aspirate. The giant multinucleated abnormal erythroblast is the striking
feature of this field. Next to it one can also appreciate a somewhat distorted
myeloblast.
Slide M19
Acute nonlymphoblastic leukemia, FAB classification M7, peripheral blood.
The pleomorphism of the leukemic megakaryoblasts, clearly apparent in this
photomicrograph, demonstrates why precise diagnosis of this type of acute
leukemia is difficult.
Slide M20
Therapy-related acute nonlymphoblastic leukemia, FAB classification M1, in
a treated myeloma patient, bone marrow aspirate. One myeloma cell and four
leukemic myeloblasts are seen in this
field.
Slide M21
Chronic granulocytic leukemia, peripheral blood smear. Neutrophilia is
clearly present, as is a modest shift to the left to the band stage. One
myelocyte and two very abnormal eosinophils are in the field. Chromosome
analysis showed the Philadelphia chromosome,
t(9;22).
Slide M22
Blast crisis in Ph+ chronic granulocytic leukemia, peripheral blood. These
blasts are extremely
immature.
