Peripheral Blood Bone Marrow and Tissue Morphology Neoplastic
Peripheral Blood, Bone Marrow, and Tissue Morphology: Neoplastic Hematology Charles Timmons, MD, Ph. D UT Southwestern Medical Center at Dallas, Texas
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1 Hx: 16 yo boy with pallor and bruising. Blood smear shows anemia, thrombocytopenia, leukocytosis (100, 000/mm 3, 90% immature cells). Flow cytometry on blood shows cells are Td. T+, CD 10+, CD 3+, CD 7+, CD 4+, and CD 8+. Interpretation: A. B. C. D. E. AML B-cell ALL T-cell ALL Hematogone hyperplasia Neuroblastoma
1 Hx: 16 yo boy with pallor and bruising. Blood smear shows anemia, thrombocytopenia, leukocytosis (100, 000/mm 3, 90% immature cells). Flow cytometry on blood shows cells are Td. T+, CD 10+, CD 3+, CD 7+, CD 4+, and CD 8+. Interpretation: A. AML B. B-cell ALL C. T-cell ALL D. E. Hematogone hyperplasia Neuroblastoma Comment: The cells are T lymphoblasts by morphology and flow cytometry. Hematogones are rarely seen in peripheral blood. High white count and large and small blasts favor T-cell ALL.
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2 Hx: 5 yo boy with bruising and cervical lymphadenopathy. Blood smear shows pancytopenia and 20% abnormal cells (pictured). Flow cytometry on marrow shows 90% of cells are Td. T+, CD 10+, CD 3+ and CD 7+. Interpretation: A. AML B. C. D. E. B-cell ALL T-cell ALL Hematogone hyperplasia Neuroblastoma
2 Hx: 5 yo boy with bruising and cervical lymphadenopathy. Blood smear shows pancytopenia and 20% abnormal cells (pictured). Flow cytometry on marrow shows 90% of cells are Td. T+, CD 10+, CD 3+ and CD 7+. Interpretation: A. AML B. B-cell ALL C. T-cell ALL D. E. Hematogone hyperplasia Neuroblastoma Comment: The cells are immunophenotypically precursor T lymphoblasts. Morphologically they correspond to the old L 2 designation from the FAB classification system.
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3 Hx: 6 yo boy with bone pain. Blood smear shows pancytopenia, and 5% circulating immature cells (pictured). Flow cytometry on marrow shows 80% cells are Td. T+, CD 10+ and CD 19+. Interpretation: A. AML B. C. D. E. B-cell ALL T-cell ALL Hematogone hyperplasia Neuroblastoma
3 Hx: 6 yo boy with bone pain. Blood smear shows pancytopenia but no blasts. Flow cytometry on marrow shows 95% cells are Td. T+, CD 10+ and CD 19+. Interpretation: A. AML B. B-cell ALL C. T-cell ALL D. E. Hematogone hyperplasia Neuroblastoma Comment: This is a blast by morphology and is B phenotype by flow cytometry. Hematogones should show more of a spectrum of maturation and are unlikely to completely replace the normal marrow elements. Solid tumor cells tend to clump rather than cluster.
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4 Hx: 15 yo boy with respiratory distress. Radiology shows cervical and mediastinal lymphadenopathy, which is biopsied. Flow cytometry shows a proliferation of cells that are Td. T+, CD 10+, CD 3+, CD 7+, CD 4+ and CD 8+. Interpretation: A. B. C. D. E. Myeloid sarcoma B lymphoblastic lymphoma T lymphoblastic lymphoma Hodgkin lymphoma Reactive process
4 Hx: 15 yo boy with respiratory distress. Radiology shows cervical and mediastinal lymphadenopathy, which is biopsied. Flow cytometry shows a proliferation of cells that are Td. T+, CD 10+, CD 3+, CD 7+, CD 4+ and CD 8+. Interpretation: A. Myeloid sarcoma B. B lymphoblastic lymphoma C. T lymphoblastic lymphoma D. E. Hodgkin lymphoma Reactive process Comment: By morphology and flow cytometry, the immature cells are precursor T lymphoblasts. An extramedullary mass of lymphoblasts is called lymphoblastic lymphoma, although it is part of a biologic continuum referred to as leukemia/lymphoma.
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5 Hx: 16 yo boy with respiratory distress. Radiology shows a mediastinal mass and a pleural effusion, which is tapped. Flow cytometry shows 90% of effusion cells are Td. T+, CD 10+, CD 3+, CD 7+, CD 4+ and CD 8+. Interpretation: A. B. C. D. E. Myeloid sarcoma B lymphoblastic lymphoma T lymphoblastic lymphoma Hodgkin lymphoma Reactive process
5 Hx: 16 yo boy with respiratory distress. Radiology shows a mediastinal mass and a pleural effusion, which is tapped. Flow cytometry shows 90% of effusion cells are Td. T+, CD 10+, CD 3+, CD 7+, CD 4+ and CD 8+. Interpretation: A. Myeloid sarcoma B. B lymphoblastic lymphoma C. T lymphoblastic lymphoma D. E. Hodgkin lymphoma Reactive process Comment: By morphology and flow cytometry, the immature cells are T lymphoblasts. An extramedullary mass of lymphoblasts is called lymphoblastic lymphoma, although it is part of a biologic continuum referred to as leukemia/lymphoma.
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6 Hx: 7 yo boy with an recent onset of vomiting and lethargy. Blood smear shows increased neutrophils with a left shift and 8% abnormal cells. Bone marrow contains 60% of the same cells. Flow cytometry shows cells are Td. T-, CD 10+, CD 19+. Interpretation: A. B. C. D. E. AML B-cell ALL T-cell ALL Burkitt leukemia/lymphoma Reactive process
6 Hx: 7 yo boy with recent onset of vomiting and lethargy. Blood has increased neutrophils with left shift and 8% abnormal cells. Bone marrow contains 60% of the same cells. Flow cytometry shows cells are Td. T-, CD 10+, CD 19+. Interpretation: A. AML B. B-cell ALL C. T-cell ALL D. E. Burkitt leukemia/lymphoma Reactive process Comment: Flow cytometry shows mature B-cells, and the morphology is that of Burkitt lymphoma, which occasionally can have a leukemic phase.
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7 Hx: 12 yo boy with vomiting, abdominal pain and weight loss. Radiology shows an ileo-cecal mass. Histology of the resection specimen is shown. Flow cytometry on the mass shows cells are Td. T-, CD 10+ and CD 19+. Interpretation: A. B. C. D. E. Myeloid sarcoma B lymphoblastic lymphoma T lymphoblastic lymphoma Burkitt lymphoma Reactive process
7 Hx: 12 yo boy with vomiting, abdominal pain and weight loss. Radiology shows an ileo-cecal mass. Histology of the resection specimen is shown. Flow cytometry on the mass shows cells are Td. T-, CD 10+ and CD 19+. Interpretation: A. Myeloid sarcoma B. B lymphoblastic lymphoma C. T lymphoblastic lymphoma D. E. Burkitt lymphoma Reactive process Comment: The “starry-sky” histology can be seen in either lymphoblastic lymphoma or Burkitt lymphoma, but the immunophenotype is of a mature B-cell, consistent with Burkitt lymphoma, and the appearance of the cells also favors Burkitt lymphoma.
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8 Hx: 14 yo boy with a single large cervical lymph node. Lymph node biopsy is shown. Flow cytometry and immunohistochemistry show cells are Td. T-, CD 19+, CD 20+, CD 3 -. Interpretation: A. Large B-cell lymphoma B. T lymphoblastic lymphoma C. D. E. Mature (Peripheral) T-cell lymphoma Hodgkin lymphoma Reactive process
8 Hx: 14 yo boy with a single large cervical lymph node. Lymph node biopsy is shown. Flow cytometry and immunohistochemistry show cells are Td. T-, CD 19+, CD 20+, CD 3 -. Interpretation: A. Large B-cell lymphoma B. T lymphoblastic lymphoma C. Mature (Peripheral) T-cell lymphoma D. E. Hodgkin lymphoma Reactive process Comment: The neoplastic cells are large and monomorphous, with the immunophenotype of mature B-cells.
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9 Hx: 18 yo boy with abdominal pain, has hepatosplenomegaly, thrombocytopenia and anemia, without adenopathy. Flow cytometry on infiltrate shows cells are Td. T-, CD 3+, CD 4 -, CD 8 -. Interpretation: A. B lymphoblastic lymphoma B. C. D. E. Burkitt lymphoma T lymphoblastic lymphoma Mature (Peripheral) T-cell lymphoma Reactive process
9 Hx: 18 yo boy with abdominal pain, has hepatosplenomegaly, thrombocytopenia and anemia, without adenopathy. Flow cytometry on infiltrate shows cells are Td. T-, CD 3+, CD 4 -, CD 8 -. Interpretation: A. B lymphoblastic lymphoma B. Burkitt lymphoma C. T lymphoblastic lymphoma D. E. Mature (Peripheral) T-cell lymphoma Reactive process Comment: The infiltrate is monomorphous, with the immunophenotype of a mature T-cell process, specifically hepatosplenic T-cell lymphoma, which typically infiltrates parenchyma rather than forming a discrete mass.
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10 Hx: 17 yo boy with fever and cervical lymphadenopathy. Lymph node biopsy shown. Immunohistochemistry shows cells are CD 3 -, CD 4+, CD 8 -, CD 30+, EMA+, ALK+. Interpretation: A. Burkitt lymphoma B. C. D. E. T lymphoblastic lymphoma Mature (Peripheral) T-cell lymphoma Hodgkin lymphoma Reactive process
10 Hx: 17 yo boy with fever and cervical lymphadenopathy. Lymph node biopsy shown. Immunohistochemistry shows cells are CD 3 -, CD 4+, CD 8 -, CD 30+, EMA+, ALK+. Interpretation: A. Burkitt lymphoma B. T lymphoblastic lymphoma C. Mature (Peripheral) T-cell lymphoma D. E. Hodgkin lymphoma Reactive process Comment: The infiltrate is composed of large, anaplastic cells with a mature T-cell immunophenotype. In this setting, ALK-positivity is helpful in calling this anaplastic large cell lymphoma.
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11 Hx: 13 yo boy with fatigue, weight loss, night sweats and splenomegaly. Peripheral blood shows anemia and leukocytosis (300, 000/mm 3). Ancillary test results include normal fetal hemoglobin and karyotype showing t(9; 22). Interpretation: A. B. C. D. E. Acute myeloid leukemia Acute lymphoblastic leukemia Chronic myelogenous leukemia Juvenile myelomonocytic leukemia Reactive process
11 Hx: 13 yo boy with fatigue, weight loss, night sweats and splenomegaly. Peripheral blood shows anemia and leukocytosis (300, 000/mm 3). Ancillary test results include normal fetal hemoglobin and karyotype showing t(9; 22). Interpretation: A. Acute myeloid leukemia B. Acute lymphoblastic leukemia C. Chronic myeloid leukemia D. E. Juvenile myelomonocytic leukemia Reactive process Comment: Marked leukocytosis with prominent basophils without increased blasts (<10%) indicate chronic phase of CML. t(9; 22)(q 34; q 11. 2) indicates a BCR/ABL 1 rearrangement.
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12 Hx: 2 yo girl with new onset of fever and bronchitis. Has maculo-papular rash and hepatosplenomegaly. Blood smear has leukocytosis (100, 000/mm 3), anemia and thrombocytopenia. Ancillary tests include fetal hemoglobin of 80% and normal blood karyotype. Interpretation: A. Acute myeloid leukemia B. Acute lymphoblastic leukemia C. Chronic myeloid leukemia D. Juvenile myelomonocytic leukemia E. Reactive process
12 Hx: 2 yo girl with new onset of fever and bronchitis. Has maculopapular rash and hepatosplenomegaly. Blood smear has leukocytosis (100, 000/mm 3), anemia and thrombocytopenia. Ancillary tests include fetal hemoglobin of 80% and normal blood karyotype. Interpretation: A. Acute myeloid leukemia B. Acute lymphoblastic leukemia C. D. E. Chronic myeloid leukemia Juvenile myelomonocytic leukemia Reactive process Comment: Marked leukocytosis including monocytosis without increased blasts, accompanied by erythroid proliferation and elevation of fetal hemoglobin is characteristic of JMML. BCR/ABL 1 fusion is not present.
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13 Hx: 1 yo boy with pallor and a rash. Blood smear shows pan cytopenia and circulating abnormal cells. Interpretation: A. Acute myeloid leukemia B. Chronic myelogenous leukemia C. Acute lymphoblastic leukemia D. E. Leukoerythroblastic reaction Infectious mononucleosis
13 Hx: 1 yo boy with pallor and a rash. Blood smear shows pan cytopenia and circulating abnormal cells. Interpretation: A. Acute myeloid leukemia B. Chronic myelogenous leukemia C. Acute lymphoblastic leukemia D. E. Leukoerythroblastic reaction Infectious mononucleosis Comment: The large blasts with ample cytoplasm and prominent nucleoli are suggestive of AML, but the Auer rod is diagnostic.
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14 Hx: 8 yo boy with bruising. Blood smear shows anemia, thrombocytopenia, and leukocytosis (30, 000/mm 3, 50% blasts). Flow cytometry on marrow shows 50% blasts with Td. T+, MPO+, CD 13+, CD 33+, partial CD 19+. Interpretation: A. Acute myeloid leukemia B. C. D. E. Chronic myelogenous leukemia Acute lymphoblastic leukemia Myelodysplastic syndrome Reactive process
14 Hx: 8 yo boy with bruising. Blood smear shows anemia, thrombocytopenia, and leukocytosis (30, 000/mm 3, 50% blasts). Flow cytometry on marrow shows 50% blasts with Td. T+, MPO+, CD 13+, CD 33+. Interpretation: A. Acute myeloid leukemia B. Chronic myelogenous leukemia C. Acute lymphoblastic leukemia D. E. Myelodysplastic syndrome Reactive process Comment: The elevated blast count indicates acute leukemia. Auer rod is diagnostic of a myeloid neoplasm, and flow cytometry agrees. Morphology shows myeloid maturation and a large blunt Auer rod, which often correlates with t(8; 21)(q 22; q 22) and RUNX 1/RUNX 1 T 1 fusion.
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15 Hx: 8 yo girl with fever, tonsillitis and lymphadenopathy. Blood smear shows anemia, thrombocytopenia, and leukocytosis (140, 000/mm 3, 60% blasts). Flow cytometry on marrow shows 60% blasts with Td. T+, MPO+, CD 13+, CD 33+, CD 11 b partial+. Interpretation: A. B. C. D. E. Acute myeloid leukemia Chronic myelogenous leukemia Acute lymphoblastic leukemia Chediak-Higashi syndrome Reactive process
15 Hx: 8 yo girl with fever, tonsillitis and lymphadenopathy. Blood smear shows anemia, thrombocytopenia, and leukocytosis (140, 000/mm 3, 60% blasts). Flow cytometry on marrow shows 60% blasts with td. T+, MPO+, CD 13+, CD 33+, CD 11 b partial+. Interpretation: A. Acute myeloid leukemia B. Chronic myeloid leukemia C. D. E. Acute lymphoblastic leukemia Chediak-Higashi syndrome Reactive process Comment: Increased blasts mark as myelomonocytic lineage, so this is AML. The strange, darkly granulated cells are abnormal eosinophils, morphology that correlates with a karyotype of inv(16) or t(16; 16).
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16 Hx: 13 yo girl with fever and swelling of one leg. Blood smear shows anemia and thrombocytopenia. WBC 3400/mm 3 with marked left shift. Marrow has 2% blasts but 82% immature myeloid cells as shown. Flow cytometry on marrow shows MPO+, CD 33+, CD 13 partial+, HLA-DR-, CD 34 -. Interpretation: A. Acute myeloid leukemia B. Chronic myelogenous leukemia C. Acute lymphoblastic leukemia D. Mast cell leukemia E. Left shift with toxic granulation
16 Hx: 13 yo girl with fever and swelling of one leg. Blood smear shows anemia and thrombocytopenia. WBC 3400/mm 3 with marked left shift. Marrow has 2% blasts but 82% immature myeloid cells as shown. Flow cytometry on marrow shows MPO+, CD 33+, HLA-DR-, CD 34 -. Interpretation: A. Acute myeloid leukemia B. Chronic myelogenous leukemia C. D. E. Acute lymphoblastic leukemia Mast cell leukemia Left shift with toxic granulation Comment: Proliferating promyelocytes, which sometimes have multiple Auer rods, rather than myeloblasts characterize the acute promyelocytic form of AML, which is associated with t(15; 17) and a PML/RARA fusion.
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17 Hx: 19 yo girl with history of treatment for ALCL 3 years prior. Now with persistent pancytopenia (WBC 800/mm 3, no circulating blasts). Marrow has 80% abnormal cells that by flow cytometry are MPO-, CD 33+, CD 34 -, CD 13+, CD 11 b+, CD 14+. Interpretation: A. B. C. D. E. Acute myeloid leukemia Juvenile myelomonocytic leukemia Acute lymphoblastic leukemia Langerhans cell histiocytosis Hemophagocytic lymphohistiocytosis
17 Hx: 19 yo girl with history of treatment for ALCL 3 years prior. Now with persistent pancytopenia (WBC 800/mm 3, no circulating blasts). Marrow has 80% abnormal cells that by flow cytometry are MPO -, CD 33+, CD 34 -, CD 13+, CD 11 b+, CD 14+. Interpretation: A. Acute myeloid leukemia B. Juvenile myelomonocytic leukemia C. D. E. Acute lymphoblastic leukemia Langerhans cell histiocytosis Hemophagocytic lymphohistiocytosis Comment: The morphology and flow cytometry are those of monoblasts, which is characteristic of therapy-related AML, especially with rearrangements of the MLL gene at chromosome 11 q 23.
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18 Hx: 1 yo boy with pallor and bruising. Blood shows anemia and thrombocytopenia, with mild leukocytosis (10, 000/mm 3, 5% circulating blasts). Marrow has 60% abnormal cells that by flow cytometry are MPO-, CD 33+, HLA-DR-, CD 34 -, glycophorin A(CD 235 a)+. Interpretation: A. B. C. D. E. Acute myeloid leukemia Juvenile myelomonocytic leukemia Acute lymphoblastic leukemia Burkitt lymphoma/leukemia Chronic parvovirus infection
18 Hx: 1 yo boy with pallor and bruising. Blood shows anemia and thrombocytopenia, with mild leukocytosis (10, 000/mm 3, 5% circulating blasts). Marrow has 60% abnormal cells that by flow cytometry are MPO-, CD 33+, HLA-DR-, CD 34 -, glycophorin A(CD 235 a)+. Interpretation: A. Acute myeloid leukemia B. Juvenile myelomonocytic leukemia C. D. E. Acute lymphoblastic leukemia Burkitt lymphoma/leukemia Chronic parvovirus infection Comment: The morphology and immunophenotype indicate a pure erythroid proliferation of blasts, without a significant myeloid component, making this the pure erythroid variant of AML.
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19 Hx: 1 yo boy with fever and weight loss. Blood shows anemia and neutropenia with 5% circulating blasts. Marrow has 95% abnormal cells that by flow cytometry are MPO-, CD 33+, CD 34 -, HLA-DR-, CD 41+, CD 61+. Interpretation: A. B. C. D. E. Acute myeloid leukemia Acute lymphoblastic leukemia Transient myeloproliferative disorder Neuroblastoma Langerhans cell histiocytosis
19 Hx: 1 yo boy with fever and weight loss. Blood shows anemia and neutropenia with 5% circulating blasts. Marrow has 95% abnormal cells that by flow cytometry are MPO-, CD 33+, CD 34 -, HLA-DR-, CD 41+, CD 61+. Interpretation: A. Acute myeloid leukemia B. Acute lymphoblastic leukemia C. Transient myeloproliferative disorder D. E. Neuroblastoma Langerhans cell histiocytosis Comment: The immunophenotype and marrow replacement indicate the megakaryoblastic variant of AML. Megakaryoblasts may be small, resembling lymphoblasts. Platelet-like cytoplasmic buds are common but not specific.
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20 Hx: 17 yo boy with inguinal lymphadenopathy. On biopsy, nodal architecture is effaced by a vaguely nodular proliferation of large atypical cells and small lymphocytes. By immunohistochemistry, the large cells are CD 20+, CD 45+, BCL 6+, EMA+, Oct 2+, BOB 1+, but CD 15 - and CD 30 -. Interpretation: A. Chronic lymphocytic lymphoma B. Burkitt lymphoma C. Classic Hodgkin lymphoma D. Nodular lymphocyte-predominant Hodgkin lymphoma E. Reactive process
20 Hx: 17 yo boy with inguinal lymphadenopathy. On biopsy, nodal architecture is effaced by a vaguely nodular proliferation of large atypical cells and small lymphocytes. By immuno-histochemistry, the large cells are CD 20+, CD 45+, BCL 6+, EMA+, Oct 2+, BOB 1+, but CD 15 - and CD 30 -. Interpretation: A. Chronic lymphocytic lymphoma B. Burkitt lymphoma C. D. E. Classic Hodgkin lymphoma Nodular lymphocyte-predominant Hodgkin lymphoma Reactive process Comment: The morphology and B-cell immunophenotype are characteristic of the L&H cells (“popcorn cells”) of nodular lymphocyte-predominant Hodgkin lymphoma.
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21 Hx: 17 yo boy with fever, night sweats, weight loss andcervical lymphadenopathy. On biopsy, nodal architecture is effaced by mixed inflammatory cells and large atypical cells. The large cells are CD 30+, CD 15+, PAX 5 weak+, but CD 20 -, CD 45 -, EMA-, Oct 2 -, BOB 1 -. Interpretation: A. Chronic lymphocytic lymphoma B. Burkitt lymphoma C. Classical Hodgkin lymphoma D. Nodular lymphocyte-predominant Hodgkin lymphoma E. Reactive process
21 Hx: 17 yo boy with fever, night sweats, weight loss andcervical lymphadenopathy. On biopsy, nodal architecture is effaced by mixed inflammatory cells and large atypical cells. The large cells are CD 30+, CD 15+, PAX 5 weak+, but CD 20 -, CD 45 -, EMA-, Oct 2 -, BOB 1 -. Interpretation: A. Chronic lymphocytic lymphoma B. Burkitt lymphoma C. D. E. Classical Hodgkin lymphoma Nodular lymphocyte-predominant Hodgkin lymphoma Reactive process Comment: The morphology and immunophenotype are characteristic of the Hodgkin cells and Reed-Sternberg cells of the classical form of Hodgkin lymphoma.
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22 Hx: 5 yo boy, 2 yrs post liver transplant, with new onset of lymphadenopathy and ascites. Radiology shows a right lower quadrant mass. A bone marrow aspirate contained the cells shown, which are CD 20+ and show in situ hybridization for EBV. Interpretation: A. B. C. D. E. Acute myeloid leukemia Acute lymphoblastic leukemia Post-transplant lymphoproliferative disorder Infectious mononucleosis Hemophagocytic lymphohistiocytosis
22 Hx: 5 yo boy, 2 yrs post liver transplant, with new onset of lymphadenopathy and ascites. A bone marrow aspirate contains the cells shown, which are CD 20+ and show in situ hybridization for EBV. Interpretation: A. Acute myeloid leukemia B. Acute lymphoblastic leukemia C. Post-transplant lymphoproliferative disorder D. Infectious mononucleosis E. Hemophagocytic lymphohistiocytosis Comment: The morphology and immunophenotype fit a large B-cell lymphoma, which here represents a monomorphous post-transplant lymphoproliferative disorder.
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23 Hx: 4 yo boy with a small painless frontal bone mass, which was resected. Radiology shows multiple lytic bony defects. The cells in the mass are CD 1 a+, S 100+, but are CD 68 -. Interpretation: A. Myeloid sarcoma B. C. D. E. Peripheral T-cell lymphoma Metastatic solid tumor Langerhans cell histiocytosis Infectious granulomatous process
23 Hx: 4 yo boy with a small painless frontal bone mass, which was resected. Radiology shows multiple lytic bony defects. The cells in the mass are CD 1 a+, S 100+, but are CD 68 -. Interpretation: A. Myeloid sarcoma B. Peripheral T-cell lymphoma C. Metastatic solid tumor D. E. Langerhans cell histiocytosis Infectious granulomatous process Comment: The morphology of twisted and reniform histiocytes with nuclear grooves, and the distinctive immunophenotype are those of Langerhans cells. The eosinophils are helpful but not essential.
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24 Hx: 6 mo girl with a large abdominal mass and elevated serum catecholamines. Bone marrow aspirations contains the cells pictured. Flow cytometry shows the cells to be CD 56+. Interpretation: A. Myeloid leukemia/sarcoma B. C. D. E. Lymphoblastic leukemia/lymphoma Natural killer cell lymphoma Metastatic Wilms tumor Metastatic neuroblastoma
24 Hx: 6 mo girl with a large abdominal mass and elevated serum catecholamines. Bone marrow aspirations contains the cells pictured. Flow cytometry shows the cells to be CD 56+. Interpretation: A. Myeloid leukemia/sarcoma B. Lymphoblastic leukemia/lymphoma C. Natural killer cell lymphoma D. E. Metastatic Wilms tumor Metastatic neuroblastoma Comment: Clumps of small cells are most likely solid tumor. CD 56 not only marks natural killer cells but is also a neural cell adhesion molecule. Small cell tumor with elevated catecholamines is diagnostic of neuroblastoma.
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