PMC8366460_01
Peripheral blood films show numerous blast-like cells with fine chromatin and high nucleus-cytoplasm (N/C) ratio along with remarkable rouleaux formation and thrombocytopenia (Wright Giemsa stain, 100x).
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F1
Peripheral blood smear was requested, which revealed strange abnormalities including premature myeloid series, severe thrombocytopenia, and some abnormal large unfamiliar cells resembling blasts in a myelodysplastic/myeloproliferative picture (Figure 1).
Bone marrow aspiration specimen revealed large blasts with open chromatin and one to three nucleoli with vacuolated cytoplasm constitute more than 20% of nucleated marrow cells (Wright Giemsa stain, (A) 10x, (B, C, D) 40x, (E) 100x)
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F2
Aspiration smears surprisingly revealed sheets of large vacuolated blasts encompassing more than 20% of nucleated marrow cells (Figure 2).
Bone marrow biopsy revealed hypercellular marrow for age mostly replaced by a diffuse infiltration of blasts (Hematoxylin Eosin stain, 10x)
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F3
Bone marrow biopsy showed hypercellular marrow for age mostly replaced by a diffuse infiltration of blasts, decrease in megakaryocytes, plasma cells less than 5%, and lymphocytes less than 10% of nucleated bone marrow cells (Figure 3).