This appeared on a Facebook group I
follow over the weekend:
History: Adult male for months complaining being unwell
with night sweat, itchy skin and weight loss.
You can access this on your phone, tablet, or PC. I think you'll have a
lot of question about this slide. After finishing your differential count, (200
cell count), what is your diagnosis.”
Well, I thought it was CMML but as for
a differential….
This morning came the update:
“Final Answer: CMML. I have annotated the virtual slide with 20
important annotations. According to WHO: Promonocytes are considered as blast
equivalents. Please review the virtual slide with the annotations.
WHO classification: Myelodysplastic/myeloproliferative neoplasms - CMMoL
Diagnositc criteria:
1. Persistent (3 months or more) peripheral monocyte count: >1.0 x
10^9/L
2. Less than 20% blasts in the PB and BM. (If >20%, it will be
acute).
3. Dysplasia in one or more myeloid lines. (in this case, there are lots
of Pergeroid neutrophils with very dense chromatin and abnormal monocytes with
clove-leaf nucleus).
4. Philadelphia chromosome or BCR/ABL1 negative.
5. No PDGFRA/PDGFRB gene rearrangement.
This is a very challenging case because of the dysplastic features of
the myeloid lineage cells. Some hypogranular myeloid cells also look like
monocytes. The dysplastic (Pergeroid) neutrophils seems to have escaped most
observers. I think if we just isolate these Pergeroid neutrophils, it may be
easier to appreciate them.
Bone marrow was done, but the slides were not included in this post. “
