PMC2941603_01
Bone marrow aspirate: Blast cells are seen along with many plasma cells (acute myelomonocytic leukemia) (Giemsa stain, 100x)
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Along with these cells were promonocytes 08%, myelocytes 06%, metamyelocytes 03%, polymorphs 02%, lymphocytes 08%, monocytes 10%, eosinophils 06% and nucleated red blood cells 10%. [Figure 1] The differential diagnosis of plamablastic myeloma and AML with reactive plasmacytosis were considered and further tests were performed to confirm the diagnosis.
Serum and urine protein electrophoresis: Polyclonal rise in gamma globulins and nonselective proteinuria, respectively
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No monoclonal protein was found even on urine protein electrophoresis [Figure 2].
Myeloperoxidase stain: Myeloid blasts are positive (100x)
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Myeloperoxidase (MPO) stain [Figure 3] showed positivity in >3% of the blasts and alpha-naphthyl butyrate esterase (ANBE) was positive in most of the blasts thus identifying them as monocytic in origin [Figure 4].
Alpha naphtyl butyrate esterase stain: Monocytic lineage is positive (monoblasts, promonocytes and monocytes) (100x)
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Myeloperoxidase (MPO) stain [Figure 3] showed positivity in >3% of the blasts and alpha-naphthyl butyrate esterase (ANBE) was positive in most of the blasts thus identifying them as monocytic in origin [Figure 4].