We present here a new case of the hematological malignancy in a-5-years-old boy.  
The main clinical sign was pancytopenia.  
The punction of the sternum followed by biopsy was performed.  
On cytological smear, blasts with large nuclei (without prominent nucleoli) and scanty cytoplasm were seen.  
The biopsy specimen was not appropriate since it mainly contained a bone structures with very few areas of bone marrow elements. Nevertheless, we also noticed the presence of large blast cells with large, oval nuclei and prominent, centrally located nucleoli and moderately abundant cytoplasm.  
Special stainings: PAS (negative)  
IHQ: CD34 (positive), MPO (positive), CD10 (negative), CD79a (negative), CD45RA (negative), CD3 (negative), TdT (not available at the moment).  
Differential diagnosis: Acute lymphoblastic or myelogenous leukemia?  
Our preliminary diagnosis: Acute myelogenous leukemia (AML).  
Please, give your opinions.

hurwitz 2007-10-09 13:51	I agree with your diagnosis of AML. The morphology on the biopsy is consistent with an AL. There are >20% of CD34+ blasts. The strongly MPO + cells might correspond to promyelocytes, those with a week MPO expression are consistent with myeloblasts. Based on these findings I would opt for AML with maturation.   Congratulations to your histology technician for the very nice preparations, in particular the beautiful giemsa.
nurija 2007-10-09 21:01	thank you Nina for interpretaion ours biopsy
metz 2007-10-10 05:21	I agree with the diagnosis of AML, probably AML with maturation(M2 in the FAB classification).
SergeyN 2007-10-10 17:10	Just a small comment.   MPO positive population is not more than 1/3 of the cellular content, mostly promyelocytes and more differentiated cells are positive and some blasts. The main blast population is MPO-CD34+.     I still think it is an AML, but would be happier with more cytology and some additional immunos.
diane.c.farhi 2007-10-11 18:06	I agree with the others and favor AML. It would be comforting to have flow cytometry, but if this is not available, then I think the current evidence is adequate for a diagnosis of AML.
hurwitz 2007-10-12 14:57	Thanks Semir and Nurja, for the nice and illustrative case, with an important take home message: high quality morphology and immunostains can be regarded as substitute for flow cytometry in rough leukemia typing. I am fully aware that many of my collegues are not happy with this statement, however a fact to be considered is that flow is not affordable in many countries, and priorities have to be defined.   I agree with Sergeys comment, most blasts are CD34+/MPO- or weekly+ which is a function of the degree of maturation of the leukemic blasts.     The final diagnosis is: AML most probably M2.
semir 2007-10-12 16:42	Thanks for all your comments concerning our case. Special thanks to Dr. Hurtwitz for her comments and closing remarks.
	» Add comment (Login)