64 yrs female with resected mediastinal mass (myeloid sarcoma)(2015), threpine biopsy (AML?)(2015) and history of MDS (2013) with BM transplant (NOT INCLUDED IN PHOTOS). Previously DCIS in the breast (NOT INCLUDED IN PHOTOS).  
HISTO 1 (MS):  
IH 1 (MONO DIFF. CD4+CD43+LCA+): LCA(++/+++)100%; CD20(-); CD3(-); PanCK(-); HLA DR(+)<5%; CD34(-); Ki67~70% (++/+++)(brand. r-ja); CD117(+/+++) 70%; MPO(-); CD68(-); CD4(+/++) 100%; CD56(-); TdT(-); GlycophorinC(-); Pax5(-); CD123(-); CD43(+)20%; CD61(++/+++) 25% (small dysplastic megas: CD61 >> vWF+?).  
 
HISTO 2 (AML?): MDS like picture with large amount of blasts, in part with GlycophorinC/Cadherin+. Definite blastic IH phenotype of MS absent.  
DESCRIPTION: Cellularity 50%. ~70% blastoid (megaloblastoid?) interstitial infiltrate. Rest of haematopoiesis: scattered NASDE+ granulopoiesis. Small and medium megas with hypolobular nuclei up to 3 DPRL. No fibrosis. Fe deposition. Central reactive lymphoid follicles.  
 
FLOW2: Blasts (small medium) ~27% of cells. IPH: CD45+, HLA-DR+, CD117+, CD33+, CD13+, CD123+bl, CD38+, CD11b+part, CD36+, CD7+ dim, CD4+, cMPO+, cCD79a-, cCD3-, cCD41-, cCD61-, CD235a-, CD34-.MYELOID+ (CD33, CD13), early stem+ (CD117, HLA-DR, CD38, CD71), NO LINE: (cMPO, cCD79a, cCD3), NO MEGA(cCD41,cCD61) NO ERYTHRO(CD235a). AML (M0) possible.  
COMMENT: possibly MONO (in part), but not enough quantitativelly...  
 
MOLECS:  
BM after Tx: 2015 05 21 Chimerizm (rec/donor) 20.78 79.22; CD34 Chimerism 52.57 47.43; CD3 Chimerism 4.26 95.74.  
AML: No AML aberrations. JAK2(-). Complex karyotype (SNP).  
Myeloid sarcoma (parafin/tissue): not evaluated yet.  
 
 
QUESTION: Blastic population in BM (MDS vs AML, blasts GlycophorinC anad CD4+?)? Different IH phenotype of blasts in MS and BM (mono vs erythroid)? CD61+ >> vWF subpopulation of dysplastic megas/blasts in MS?

tzankov 2015-06-04 12:23	I fully agree with you - MDS-rlated AML relapse in the BM and in the mediastinum with monoblastic features and phenotype, if possible I would suggest staining for CD11c and CD14. I am not sure that a "definite blastic IH phenotype of MS is absent" since monoblastic markers like CD11c and CD14 are not stained. Finally, the possibility (theoretically) of a donot-type AML can be considered.   Common cytogenetic cahnges in the former (2013) and present (2015) blasts?   Chimerism?
ugnius 2015-06-04 15:22	Thanx. CD11c and CD14 absent there still. Nowadays molecs not done. Previously (on MDS) I will check. The patient unfortunatelly is going into pallation regimen... Chimerism data included above.
ugnius 2015-06-04 16:30	AML molecs included: NOS. Complex kayotype. MS (tissue) not evaluated yet.