PMC3606751_01
(a) Bone marrow biopsy, H&E stain, 4x image showing hypercellular marrow. (b) Bone marrow biopsy, 40x image showing large cells with prominent nucleoli.
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fig1
Bone marrow biopsy and aspirate revealed a hypercellular marrow almost completely replaced by a diffuse infiltrate of large lymphoid cells (Figures 1(a) and 1(b)) with basophilic cytoplasm, cytoplasmic vacuoles, and large prominent nucleoli (L3/Burkitt lymphoma-like morphology) (Figure 2).
Aspirate smear, Wright-Giemsa stain, 100x image showing the neoplastic lymphoid cells with basophilic cytoplasm, cytoplasmic vacuoles, and large prominent nucleoli.
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fig2
Bone marrow biopsy and aspirate revealed a hypercellular marrow almost completely replaced by a diffuse infiltrate of large lymphoid cells (Figures 1(a) and 1(b)) with basophilic cytoplasm, cytoplasmic vacuoles, and large prominent nucleoli (L3/Burkitt lymphoma-like morphology) (Figure 2).
Peripheral smear, Wright-Giemsa stain, 100x image showing an abnormal circulating lymphoid cell with the same cytology as the lymphoid cells in the bone marrow.
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fig3
A peripheral smear showed few circulating abnormal lymphoid cells (5%) with the same cytologic features as the cells found in the bone marrow (Figure 3).
TdT staining abundant cells in bone marrow.
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fig4
Further characterization of the lymphoid cells using Immunohistochemical stains showed positivity for TdT (Figure 4), CD10, CD20, MUM-1, PAX5, and BCL 2. Interphase FISH analysis for t(9;22) and a MYC gene translocation revealed multiple genetic alterations including: a cell line with a normal chromosome 9 and 22 and concurrent MYC translocation; a cell line with a normal chromosome 9 and 22 and a MYC translocation with an extra copy of MYC translocated to chromosome 7; a cell line with both a t(9;22) and MYC translocation (Figures 4, 5, and 6).
Interphase FISH analysis showing a normal chromosome 9 and 22, MYC gene translocation, and an extra red MYC signal translocated onto chromosome 7.
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fig5
Interphase FISH analysis for t(9;22) and a MYC gene translocation revealed multiple genetic alterations including: a cell line with a normal chromosome 9 and 22 and concurrent MYC translocation; a cell line with a normal chromosome 9 and 22 and a MYC translocation with an extra copy of MYC translocated to chromosome 7; a cell line with both a t(9;22) and MYC translocation (Figures 4, 5, and 6).
Interphase FISH analysis showing a t(9;22) and MYC gene translocation.
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fig6
Interphase FISH analysis for t(9;22) and a MYC gene translocation revealed multiple genetic alterations including: a cell line with a normal chromosome 9 and 22 and concurrent MYC translocation; a cell line with a normal chromosome 9 and 22 and a MYC translocation with an extra copy of MYC translocated to chromosome 7; a cell line with both a t(9;22) and MYC translocation (Figures 4, 5, and 6).