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