1 yrs old child (male) without Down phenotype.  
STORY (BASED ON CLIN DATA):  
AML diagnosed from birth: chemotherapy never administered (with hope for spontanous remission)!  
 
2013 April: erythematous eruption from birth: skin (tigh) biopsy was taken and AML confirmed. IH: CD117(+++); TdT(-); MPO(++)30%; CD34(-); CD79a(-); CD10(-); Bcl2(+++); Pax5(-); Ki67 30%(++)(brand. r-ja); CD3(-).  
2013 March: BM aspirate description (cited): normocellular BM. A lot of blastic cells: pleomorphic with large nucleoli and focally with scattered vacuolisation of cytoplasm. Granuliopoiesis and erythropoiesis depressed. Megakariocytes are absent.  
2013 June flow 1: ~13% blastic population: CD45+bl, CD34+, CD33+, CD7+, CD117+, CD38+, CD4+bl, HLA-DR-, CD13-. ~ 21% regenerating B LBL/haematogones: CD45+bl, CD10+, CD19+, CD20+ het, CD34+dal, CD38++,HLA-DR+. Išvada:  
2013 Sptember flow 2: Blastic population in BM (1,45%) with abberant IH: CD45+ bl, CD34+, CD38+, CD117+, CD13+ bl, CD33+, CD7+, CD4+ weak, HLA-DR-. 41,46% regenerating B LBL/haematogones: CD45+ bl, CD10+, CD19+, CD20+ het, CD34+ dal, CD38++, HLA-DR+.  
 
From 2014 Jan: anaemia and thrombocytopenia progressed.  
THREPINE 1 (2014 March): HEAVILLY FRAGMENTED AND SMALL: massive erythroid and myelopoietic depression, massive megakaryopoietic hyperplasia/ dysplasia with abberancy: CD56+ CD7+ CD61+ VWF+/- CD117+ and trisomy 21. B LBL/haematogone hyperplasia 20% with aberant IH: TDT-/+; CD79A+ > CD20+; CD10+; HLA DR+): changes are compatible at least with MDS, but in context of cutaneous leukaemid (2013) with AML (AML M7) diagnosis. Reticulin fibrosis MF-1.  
 
FLOW 3: ~3,96% blast population with aberant (identical to previously diagnosed AML): CD45+ weak, CD34+, CD33+, CD7+, CD117+, CD38+, CD4+bl, HLA-DR-, CD13-.  
~30% regenerating B lymphoblasts (hematogones): CD45+bl, CD10+, CD19+, CD20+ het, CD34+dal, CD38++,HLA-DR+.  
MOLECS 1: trisomy 21 (conventional cytogenetics, bone marrow).  
 
THREPINE 2 (2014 August): the same findings.  
FLOW 4: ~0,79% blast population: CD45+bl, CD34+, CD33+, CD7+, CD117+, CD38+, CD4+bl, HLA-DR-, CD13-.  
~4,19% regenerating B LBL (hematogones): CD45+weak, CD10+, CD19+, CD20+ heterogenous, CD34+ partial, CD38++,HLA-DR+. MOLECS 2: Any fixed AML aberrration were found. Karyotyping NORMAL by SNP array (bone marrow).  
 
PROPOSED DIAGNOSIS (from my side): AML (probably M7), asociated with trisomy 21 vs MDS vs ???  
 
COMMENTS/SPECIAL POINTS:  
1. I think both aspirates for flow and maybe for molecs were HYPERDILUTED. Prominent magakaryocomponent not seen and not described in flow and aspirate descriptions, but dominating in BM.  
2. I'm curious about "dissapeared" trisomy...  
3. "Abberancy" on megas (IH) vs artifacts (CD117, CD7, CD56).  
4. Large amount of haematogones?  
5. Diminishing from 2013 (13%) "blastic" population in flow...  
 
Thank you for beeing together.