I got the results of NEQAS 2501DM today.
“You are asked your opinion of this
blood film that was prepared from a 64-year old female who had attended her GP
complaining of tiredness. The automated analyser had reported a lymphocytosis
with a flag indicating the possible presence of blast cells”.
I saw
Rbc
Rouleaux
Wbc
Lymphocytes with blebbing
Lymmphocytes with Burkett-like vacuoles
Smear cells
Blast cells
Dysplastic neutrophils
Toxic granulation
Plt
Giant platelets
I felt this was something lymphoproliferative.
The expert opinion said ”The abnormal
cells are variable. However, most cells have a mature appearance, and the
preservation of neutrophil and platelet numbers makes a diagnosis of acute
leukaemia less likely. Furthermore, the overall nuclear and cytoplasmic
features are not typical of either circulating blast cells. Making a
morphological diagnosis of MCL can be difficult and we can rarely (if ever) be
confident of the diagnosis using morphology alone. However, MCL is a
potentially aggressive disorder, so it is important not to simply report the
appearances as reactive. Features to look for include – marked variability
between malignant cells with some cells looking quite mature and others more
aggressive; a variable but often abundant and basophilic cytoplasm; and nuclear
complexity, classically indented but often quite variable. Confirmation can
then be made using marker studies and molecular testing.”
Which (quite frankly) means that I’d
spotted the salient features and gone about as far as I could with a
microscope. I’ll take that as a success.
No comments:
Post a Comment