I won’t lie. I don’t know. It’s AML. Back
in the day we’d do a Sudan Black stain and that was good enough. Things have massively changed in the
understanding and diagnosis of leukaemia.
Here’s the answer:
“Correct answers are A and B. This
case illustrates a discrepancy between the two AML classification systems and
underscores the complexity of diagnosis in the presence of multiple genetic
alterations. An integrated diagnostic approach, including flow cytometry,
cytogenetics, and molecular genetics, is necessary to reach a final diagnosis.
The patient would be classified as an AML with mutated TP53 according to ICC
2022 and as an AML myelodysplasia-related according to WHO 2022. In the ICC
2022 classification, AML with mutated TP53 is recognized as a separate entity,
including Pure Erythroid Leukemia, if morphologic criteria for this entity are
respected. According to WHO 2022, 5q
deletion is included in the cytogenetic abnormalities defining AML-MR. In both systems, the diagnosis of AEL (WHO
2022) or PEL (ICC 2022) requires ≥30% immature
erythroid cells (proerythroblasts) and a bone marrow with erythroid
predominance (≥80% of cellularity). The case of this
patient doesn't comply with the criteria of the >30% proerythroblasts (he
does have 45% of erythropoiesis in the BM, but not 30% or proerythroblasts)”.
Here’s
a link to an article on the matter from an expert panel. I’ll make the
observation that it wasn’t that long ago that we were all far more knowledgeable
on the matter as we used to do a lot of the testing in-house and not send it
off to reference labs…
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