A man, 28 Y old, with a blood infiltration by indifferentiated little round cells. We can observe nucleili inside the nucleus and little vacuoles in the cytoplasm.  
Of course this can be an acute leukemia. However some complementary investigations must be performed to define the immunological phenotype of these cells. Is it possible?

The morphology speaks very much in favour of Acute myelöid leukemia ( AML-M2). Can Facs -analysis and cytogenetics be performed?

considering all, clinical details, diff. count and morphology, I favor acute myleoid leukemia. if sophisticated analyses could not be performed, at least cytochemistry for peroxidase (MPO) should be done!

I agree with my colleagues that it looks like an AML. Sadly due to the pictures quality is impossible to see fine details. DD M2 or M4? Of course further analysis like special tinction (peroxidase and esterase) would help in the differential diagnosis if cytometry is not available.

Would vote for AML, too. The other possibility - PLL - seems much less probable.  
 
Nevertheless, I would join my colleagues and ask for cytochemistry to be sure. Really, peroxidase stain is technically so simple.

Thanks everyone, I released the peripheral smear report as Acute leukemia, probably AML-M2 & advised cytochemistry & immunophenotyping. The patient has been referred to the oncology center and further work up will be done there.

Sorry to be late, but have been away.  
I agree this is Acute Leukaemia. Classification should be attempted on marrow rather than blood, but on the material available, I would favour Acute Myeloblastic Leukaemia, and in view of the presence of some mature granulocytic cells in the blood, Acute myeloblastic leukaemia with maturation (M2 in the FAB classification) seems reasonable.

I have also been away and apologize for this late comment. I agree that it looks most like AML, but requires special stains, preferably MPO, or flow cytometry to confirm the diagnosis. Have either of these been done yet? Is the patient being treated?