PMC8101669_01
(a) Hypercellular marrow showing expansion of granulopoiesis and increase in megakaryocytes. (b) Atypical megakaryocytes showing cloud-like, hypolobulated, and hyperchromatic nuclei, abnormally dislocated toward the trabecular bone. (c) Atypical megakaryocytes with cloud like nuclei in bone marrow aspirate. (d) Reticulin fibrosis grade 1 [H and E 40X]
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F1
Frequent hypolobated forms as well as cloud-like nuclei were seen [Figure 1]. Reticulin stain showed grade 0-I reticulin fibrosis, showing loose network of linear reticulin fibers with focal intersections [Figure 1].
Glomeruli showing expansion of mesangial matrix with mild increase in mesangial cellularity. Interstitial inflammation seen [Periodic Acid Schiff stain, 40X].
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F2
Rest of the glomeruli showed diffuse mild to moderate mesangial hypercellularity and mesangial matrix expansion [Figure 2].
Direct immunofluorescence showing mesangial and peripheral capillary loops granular staining of IgA (3+), IgG (2+), C1q (2+), and C3 (3+)
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F3
Sample for DIF contained seven glomeruli and revealed mesangial and glomerular capillary loops granular staining for immunoglobulin G (IgG) (2+), IgA (3+), immunoglobulin M (IgM) (2+), and complement components including C1q (2+) and C3 (3+) [Figure 3].