Patient is a 28 years old male

Clinical-Pathology notes: Low grade pyrexia with bleeding gums for last 2-3 months. Peripheral blood showed Magaloblastic Anemia with thrombocytopenia (Platelets- 46 K/ul) and presence of 10-12% atypical immature cells (blasts).

Proposed Clinical Diagnosis: Magaloblastic Anemia versus Acute Leukemia.

Bone Marrow Aspirate Cytology : Shows hypercellular marrow mostly replaced by highly proliferating, large atypical leucoblasts with conspicuous well-punched out vacuolization. Three images from bone marrow aspirate smears are presented here:

Figure 1: Giemsa (100X)
Figure 2: Myeloperoxidase staining with Giemsa counter staining (100X)
Figure 3: Myeloperoxidase staining with Safranin counter staining (100X)

Proposed Laboratory Diagnosis: APML (M-3) with unusual morphology of Promyelocytes (Non-granular with cytoplasmic vacuolization).

Note:This case without cytochemistry (MPO staining) can be confused with L-3 as the morphology closely resembles that of Lymphoblasts, except the size of the cells in this case is very large.

Please, send your comments to: Dr. G.D. Mody Jaipur (India)
gdmody@eth.net

Figure 1

Figure 2

Figure 3