[comment sent by email on Mon, 2 Mar 2015 18:37:00 +0300] Was it a dry tap rather than hypocellular as I do not see any marrow
particles? If there are particles you could move to where they are and
send some images. The cells certainly are atypical, look myeloid and have
characteristics of megakaryoblasts (??AML FAB class M7) and this could
explain the dry tap. I would suggest you try a trephine biopsy (and an
aspirate at the same seating) for definitive answer. Flow cytometry would
be useful.
The cells look like very atypical.
Some additional information will be necessary for a more definite opinion.
1. Do you have more data on the patient's blood counts?
2. Was there a staging work-up done (at least, external lymph nodes, thoracic RX and abdominal USG?
3. Could you make a photo of a thinner field (where erythrocytes don't overlap)?
4. Do you have additional methods like trephine biopsy and flow cytometry available?
I post this comment on behalf of Dr. Alicia Rovo, Berne, Switzerland, who reviewed this case:
"There are 3 pictures, in all of them presence of large cells, the quality of the pictures do not allow fine morphological description. The cells do not belong to normal hematological cells. Some of them clearly with blast aspect. Some of the largest with presence of “blebs” which make remember megakaryoblast cells.
It could be compatible with leukemia, of course due to the technical limitation it is here no possible to approach a definitive diagnosis."
