22 January 2015 (Thursday) - Digital Morphology Result

Personally I can't help but feel that the report takes a little too long to come back - I can't really remember much about what I said at the time. I'm pleased I didn't miss any of the really salient features

CPD Report
Participant: Me!!
CPD Date: 2015-01-02 13:18:00
Total Number of Participants: 1089
Case Identifier: 1406DM
Consensus of Morphological features recorded:
Your Observations: Rank Morphological Feature Participants who selected this feature 1 Blast cells 6.5% 2 Promyelocytes 13.7% 3 Nucleated RBCs 73.2% 4 Thrombocytopenia 70%
Other participants' Observations Rank Morphological Feature Participants who selected this feature 1 Nucleated RBCs 73.2% 2 Thrombocytopenia 70% 3 Polychromatic RBC 54.4% 4 Myelocytes 38.8% 5 Punctate Basophilia 26.7%
Which one of the statements below best sums up your own view of this case?
I believe this is clearly neoplastic, although confirmation will be required.
What diagnosis best fits the morphological impression in this case?
Actual pathological diagnosis:
Chronic myelomonocytic leukaemia (CMML)
Brief Morphology Panel Comments:
More than 1000 individuals completed this case. The most popular morphological selections reflected the features of marrow infiltration (nucleated erythroid cells, thrombocytopenia, polychomasia, myelocytes), these were accompanied by frequent choices indicating dysplasia or monocytosis. These features reflected the most frequent abnormalities, and gave a good feel for the findings. More than 50% of participants were (correctly) confident to diagnose a neoplastic disorder with a further 25% considering neoplasia as a possible explanation. Many chose to submit a diagnosis, and of these a very clear majority correctly diagnosed CMML with a substantial proportion of the remainder diagnosing a form of myelodysplasia. This is a good outcome. No single feature of the case supported diagnosis of a specific condition, and the final conclusion required the bringing together and interpreting of a range of morphological features. Further details are provided with the annotation.