PMC3420696_01
The initial bone marrow biopsy showing panhyperplasia with focal clustering of megakaryocytes (a) and (b) as well as dyspoietic multinucleated megakaryocytes (c) and dysplastic erythroid precursors (d) are seen. Severe reticulin fibrosis in the initial biopsy was also noted (e).
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PMC3420696_01_CRIM.HEMATOLOGY2012-207537.001.jpg
fig1
The bone marrow biopsy showed a markedly hypercellular bone marrow at 90% cellularity with panhyperplasia (Figure 1).
Peripheral blood smear (a) and the followup bone marrow at two months after initial presentation. Peripheral blood smear show marked pancytopenia with rare circulating lymphoblasts ((a) and inset). Bone marrow smear (b) and biopsy (c) showing sheets and clusters of lymphoblasts. These blasts show diffuse strong cytoplasmic staining for CD10 (d), diffuse nuclear staining for Terminal deoxynucleotidyl transferase (e), but were negative for CD34 (f).
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PMC3420696_01_CRIM.HEMATOLOGY2012-207537.002.jpg
fig2
Rare circulating blasts were identified in the peripheral blood smears (Figure 2(a)). Bone marrow biopsy was then performed and showed markedly hypercellular (98%) with 82% B-lymphoblast population (Figures 2(b)-2(f)).