CASE IS READY. I'M SORRY FOR ABSENSE OF "CONFOCALLITY" (FRAGMENTATION OF THE SECTIONS):  
 
61 yrs female (MD) with aggressive clinics with suspition of the disseminated neoplastic process (vertebral fractures, radiologic multiple focci in the liver, adrenal, spleen, supraclavicular nodes. NO BIOPSIES before Exitus, except isolated THREPINE (below).  
CLINICS: weakness, bed regimen only, icterus, hepatic and pulmonary insuficiency, ECOG 3, cutaneous haematomas, edema of the legs, hydrothorax, DIK sindrome, etc... Shortly after threpine biopsy- Exitus letalis in the outer clinics (further data unknown).  
BLOOD: WBC 6,46; Anemia (E 1,96; Hb 64), throbocytopenia (T 27), Kreatinine 30, Bilirubin gen. 350,5; LDH high: 1506. Blasts in the aspirate not found (diluted specimen).  
In 2015 herpetic eruption in the chest and legs (before main disease course).  
TREATMENT: pallation, blood transfusions.  
CLINICIAN OPINION: Nothing definite.  
 
HISTO: a) Panhyperplasia of BM, massive erythroid hyperplasia/dyserythropoiesis;  
b) Reticulin and collagen fibrosis MF2 up to 70% space with "blastoid" cells clusters up to 25% of population and "retiform" or spindled fibroblastic proliferation, focal neoosteogenesis;  
 
IH: a) "blastoid" cells in the fibroblastic areas: CD34+; Bcl2+; CD10+ (?); MPO/CD68/CD123/CD117/HLA DR/TdT(-); Pax5/CD3(-);  
b) Spindle cells in myxoid background ERG+, CD34/CD31+ focally.  
NO EPITHELIAL tumor cells detected.  
 
 
PROPOSAL: Acute panmyelosis/myelofibrosis (AML subvariant)???  
Extramyeloid ANY kind of tumor/proliferation (myueloid sarcoma? other tumor/mts?) cannot be excluded.