ALL blasts look the same on routine stains, whether they are myeloblasts, lymphoblasts, monoblasts, etc.
TOXIC GRANULES are EXAGGERATIONS of the marrow’s normal granularity, DOHLE bodies are fragments of remaining dilated rough ER
Not only are basophils RARE to find normally, but pure “basophilia” is also VERY rare.
Why would monocytosis be linked to granulomatous diseases? Answer: Monocytes are macrophages in circulation, and granulomatous diseaseas are macrophage diseases.
EXTRAMEDULLARY HEMATOPOESIS is most common in the spleen, liver, and lymph nodes.
If a CML had much more than 10% blasts, you might suspect that the patient was going into a “blast crisis”.
This marrow is virtually 100% cellularity!!! This is the HALLMARK of CML, and all the cells are still marrow cells although blasts are INCREASED, i.e., more than 1-2 % This marrow is virtually 100% cellularity!!! This is the HALLMARK of CML, and all the cells are still marrow cells although blasts are INCREASED, i.e., more than 1-2 %
This marrow is virtually 100% cellularity!!! This is the HALLMARK of CML, and all the cells are still marrow cells although blasts are INCREASED, i.e., more than 1-2 %. In this CML megakaryocytes are proliferating so what OTHER myeloproliferative disease could this be confused with? Ans: essential thrombocythemia (essential thrombocytosis)
Note most of the marrow looks “fibrotic”. What stain could help you confirm that this is fibrous tissue? (trichrome)
The most life saving thing you can learn today is how to recognize a blast! HUGE NUCLEUS NUCLEOLI (stain LIGHTER not DARKER than the rest of the nucleus on Wright stain), How many nucleoli does that one blast cell have? Answer: 3 NO cytoplasmic differentiation
Many cells from CLL have a “smudge” or “basket” appearance
Please those THREE diagnostic features of plasma cells, the malignant plasma cells of MM look like normal plasma cells usually.
Normal on left, myeloma on right.
Note the “lytic” lesions
Blasts, blasts with AUER rods
Acute promyelocytic leukemia, remember promyelocytes have BOTH nucleoli AND nonspecific granules, true BLASTS do NOT have granules.
In AMML, M4, many of the peripheral leukemic cells look like monocytes, while in M5, Acute Monocytic Leukemia, MOST of them look like monocytes
In M6, many of the cells may resemble erythroid cells, in M7, many of the cells may resemble megakaryocytes
Know the difference between a myelo-”proliferative” and a myelo-”dysplastic” disease.
BENIGN FOLLICULAR HYPERPLASIA. Larger and more numerous than normal follicles. MEDULLA may be compromised.
BENIGN SINUS HISTIOCYTOSIS. The cortical area may be compromised. SINUS HISTIOCYTOSIS may be seen in reaction to cancer, even if there are NO tumor cells in the lymph node.
“ HAIRY” cell leukemia/lymphoma consists of lymphocytes which look hairy.
Most pathologists HATE lymphoma classifications with a passion!
I HATE this slide.
I HATE this slide even worse.
Prognosis of HD disease is related directly of percentage of lymphocytes and inversely to number of RS cells.
STERNBERG REED cells are called “lacunar” cells in one of the most common forms of HD called NODULAR SCLEROSING
The subcapsular sinus of the lymph node is the FIRST place you will spot a metastatic tumor nest!
Notice the “confluence” of WHITE pulp? Could this be lymphoma involvement? Ans: Yes Could this be granulomas? Ans: YES
Portal hypertension, prominence of RED pulp
Note all these are benign. The commonest MALIGNANT tumor primary to the spleen is a LYMPHOMA
Hassal’s corpuscles are fused epithelial reticular cells