poorly processed/poorly won BMB of a hypercellular marrow with more or less normally appearing megas, eosinophila, B-cell predominant lymphocytosis, increased mcirovascular density, scattered CD34+ blast equivanlents and TdT+ hematogones. I would favor a ractive process with all the caveats of the poor morphology...

Thank you prof for your comments,if you do not mind you could point out which part of processing do you think needs to be iimproved

well the section is really very very thick, which could be related to poor dehydration or skipped cooling down of the paraffin blocks prior to slicing

Forgive this late comment about BM processing:in our practice , we got an easy 3 µ cutting , good MMG staining and a wide range of antibodies use with Harmann Lowy fixative.It allows a 20hours fixaztion without further decalcification .The main obstacle is not to spread our an environmental fixative containing 2,5% HgCl2.It must be neutralized after use with Thioacétamide ( details in our paper: Pathology Research.Practice , 190 , 1149-1161 , 1994).An alternative would be the Hammersmith protocol (Kikkery Naresh... ,J clin Pathol , 2006 , 59 , 903-911)

The Department of Pathology at the University of Nairobi has a high standard histology laboratory, with excellent technique bone marrow biopsies included. Therefore it seems appropriate to try to find out what exactly happened in this particular case and stick to well established methods. I remember showing in one of my talks two bone marrow biopsies one processed at the Department of Pathology, University of Nairobi, and another processed at the Department of Pathology, University of Basel. People could not tell the difference.

Thank you for your comments,let me share with the technical team and see how to go about it.This specimen was processed at Eldoret,Kenya we started processing clot sections and trephine recently may be we need training on the same