PMC6431525_01
Case 1. The patient with final diagnosis of megaloblastic hemopathy (pernicious anemia). (a) Microscopic panoramic image to show the general aspect of BMC (H&E, 10x). Each grouping of hematopoietic material is called spicule. Five spicules are necessary to consider a material representative for analysis. The utilized criteria to render MC are the same used to interpret BMB. (b) Erythroid hyperplasia with numerous megaloblasts (H&E, 400x). (c) Demonstration of histochemical staining application on MC (Perls, 400x). In the image, hemosiderin deposits are stained blue. (d) Application of reticulin histochemical staining on MC (reticulin, 400x). Reticulin fibers are stained black. It is possible to evaluate this network with this technique similarly to BMB.
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Hemogram with pancytopenia and macrocytosis and high lactate dehydrogenase (LDH) (Figure 2).
PMC6431525_02
Case 2. The patient with final diagnosis of multiple myeloma. (a) Histological section showing a small grouping of plasmocytes in the middle (H&E, 400x). (b) Utilization of IHC to detect, confirm, and quantify plasmocytes (IHQ, CD138, 400x). Resource applied for diagnosis and posttreatment reevaluations. IHC evaluation confirming that plasmocytes present restriction of immunoglobulin light kappa chain, indicating the diagnosis of multiple myeloma: (c) (kappa, 400x) and (d) (lambda, 400x).
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X-rays showed multiple lytic lesions in the axial skeleton (Figure 3).
PMC6431525_03
Case 3. The patient with final diagnosis of chronic lymphocytic leukemia (CLL). (a) BMC, in small magnification, showing intense hypercellularity of bone marrow with lymphoid accumulation (H&E, 40x). (b) Cell details, characterizing lymphocytes as small and typical of this neoplasia with hyperchromatic nuclei and regular membrane (H&E, 400x). (c) Immunopositivity for CD20, confirming B-cell origin of the neoplasia (IHC, CD20, 200x). (d) Contrast in lymphoid accumulation, showing a small percentage of T lymphocytes (IHC, CD3, 200x). (e) Immunopositivity overlapping for CD5 in neoplastic B cells (IHC, CD5, 200x). (f) Immunopositivity for CD23 allows diagnosis of CLL (IHQ, CD23, 200x). Note the quality of immunostaining in the images. In BMB samples, due to calcification, color irregularities can compromise analysis and make precise diagnostics sometimes difficult.
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