CASE IS OPEN AND READY.  
54 yrs old male.  
HISTORY: progressing pancytopenia. Primary aspirate: up to 19% blasts.  
BLOOD: WBC (*10e9/l) 2,02 ; NEU (*10e9/l) 0,21; RBC (*10e12/l) 2,72; HgB (g/l) 90; Plt (x10e9/l) 75.  
ASPIRATE (now): Blasts 26,0%; Erythropoiesis expanded, normoblastic, dyserythropoietic; Granulopoiesis: diminished, hypogranulated, irregularly segmented.  
HISTO: Massivelly effaced architecture with prominent atypical erthroid hyperplasia/dysplasia (with giant nuclei)up to 40% visually, immature myeloid precursors up to 25%, dysplastic megakaryopoiesis.  
IH: CD34+ infiltration absent; CD117+ precursors up to 25% (peritrabecular and interstitial); CD123+ single cells; TdT+ single cells; HLA-DR+ population up to 15%; ATYPICAL ERYTHROID: p53 (+/+++) 100%; GlycophorinC (++/+++)100%. Megas vWF+.  
FLOW: Blastic population ~ 16 % nucleated cells (moderate caliber). IH: CD45+ weak, CD34+, CD38+, CD71+ weak, CD117+, HLA-DR+, CD13+ dim, CD33+, cMPO+ weak, CD11b-, CD14-, CD15-, CD56-, CD64-. Blasts- of MYELOID genenesis. Signs of dysgranulopoiesis, irregular CD11b/CD13/CD16 expression.  
VISUALISATION: Aperio (username guest, if required).  
MOLECS: No known abnormalities was present (PML/RARA t(15;17)(q22;q21); AML1/ETO t(8;21)(q22;q22); CBFB/MYH11 inv(16)(p13;q22); CEBPA; FLT3 ITD; NPM1;  
DEK/NUP214 t(6;9)(p23;q34)).  
 
PROPOSAL: AML, M6 (?) at least 25% BM space (visible myeloid precursors), probably associated with MDS/RCMD.  
CONTRA: By flow and in aspirate erythrokaryocytic population not exceeds 50%.  
 
Thankyoualot

tzankov 2013-07-03 07:25	Dear Ugnius,   as always perfectly documented and worked-up case. Actually, what you observe is in my personal opnion the usual presentation of erythroleukemia with "background" dysplastic changes and increased erythroid blasts. At the moment the diagnosis more or less (!) fits to M6A since there are 26% blasts in the aspirate and only focally there are approx. 50% erythroid blast in the biopsy. Since I am intersted in one protein, would you be so kind to send me 3 unstained slides on SF+?
ugnius 2013-07-03 07:35	Thanx, dear Alex. Sure- I will do that with pleasure. You mean SF+ as highly adhessive slides used for IH?
Githanga 2013-07-03 21:19	Thank you! I have enjoyed reading this case and looking at the excellent pictures. Agree it is M6
tzankov 2013-07-05 07:31	yes, please highly adhesive slides
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