63yrs old male underwent threpine biopsy due to progressive anemia, throbocytopenia, left shift of granulopoesis. There are any signs of hepatosplenomegaly and long stand clinical history (Acute onset).  
The patient was treated due to laryngeal carcinoma 1999-2000.  
CLINICAL DATA WILL BE ATTACHED SOON IN DETAIL.  
 
HISTO: Promiment III-IV collagenous/reticulin fibrosis without clustering of mega's. Granulopoesis depressed. The single erythroid islands are present (Hb+). Large and medium sized dysplastic megakaryocytes with irregular nuclei up to 30 HPF. CD34/TdT/Bcl2/CD117+ blastic cells are not vissible. PanCK(-). Iron stain is negative.  
 
DIFFERENTIAL: BM collagenous IV mielofibrosis: acute myelofibrosis vs MDS with fibrosis vs CMPD: MF.  
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