MDS-AML

oval macrocytes; hypochromic microcytes RBCs; Abnormal nucleus

Dyserythropoiesis:

Abnormal granulation and nuclear shapes; Uneven cytoplasmic staining

Dysmyelopoiesis:

Giant platelets; Abnormal granulation; Micromegakaryocytes

Dysmegakaryopoiesis:

MDS with defining genetic abnormalities

Myelodysplastic neoplasm with low blasts and isolated 5q deletion

Myelodysplastic neoplasm with low blasts and SF3B1

Myelodysplastic neoplasm with Bialleic TP53 Inactivation

Blasts: <2% (PB); <5% (BM)

Myelodysplastic neoplasm with low blasts and isolated 5q deletion

Blasts: <20% (BM & PB)

Myelodysplastic neoplasm with Bialleic TP53 Inactivation

SF3B1 Mutation; Ringed sideroblasts: 5%

≥ 15% RS

Good prognosis

Myelodysplastic neoplasm with low blasts and SF3B1

MDS: Morphologically defined

MDS with low blasts (MDS-LB)

MDS hypoplastic (MDS-h)

MDS with increased blasts (MDS-IB)

Blasts: < 5% (BM); < 2% PB

Dysplasia in 1 cell line

MDS with low blasts (MDS-LB)

Blasts < 5% (BM); < 2% PB

MDS hypoplastic (MDS-h)

Types: 1, 2, with fibrosis

MDS with increased blasts (MDS-IB)

Monocytosis (>5 x 10^9/L for > 3 months)

<20% blasts and promonocytes (PB & BM)

MDS/MPN: Ch Myelomonocytic Leukemia

WBC < 13 x 10^9/L

Myelodysplastic CMML:

WBC ≥ 13 x 10^9/L

Myeloproliferative CMML:

MDS/MPN with neutrophilia

Dysgranulopoiesis

Leukocytosis

Multilineage dysplasia

Pseudo Pelger-Huet

MDS/MPN: Atypical Ch Myeloid Leukemia

SF3B1 Mutation. ≥ 15% ring sideroblasts

Anemia, dysplasia (erythroid lineage)

Platelet count: ≥ 450 x 10^9/L

MDS/MPN: with SF3B1 mutation and thrombocytes

based on the number of WBC in peripheral blood (PB) → if WBC count is higher or more than 15x 10^9 /L

Leukemic:

leukemia if WBC count less than 15x 10^9 /L. Absence of leukemic or blast cells in the circulation, leukemic cells are confined ONLY in bone marrow

Aleukemic:

leukemia if WBC count less than 15x 10^9 /L

Subleukemic:

increased in blast: myeloblast (>30%); stem cell disorder; elderly and newborns

Acute Myeloid Leukemia (AML)

decreased blast (30%); common in children

Chronic Myeloid Leukemia (CML)

Increased in blast; lymphoblast (≥ 30%); common in children

Acute Lymphoblastic Leukemia (ALL)

decreased blast (≤30%); increase mature cell; lymphocytes

Chronic Lymphoblastic Leukemia (CLL)

stem cell disorder with predominance of Blast Cells (>20%) in the blood or marrow and may resemble acute infection at presentation. It affects all ages, but increases with older age (>60 years). This is also the most common form of acute leukemia during the first few months of life

Acute Myelocytic Leukemia

Key myeloid antigens of AML

Myeloperoxidase,

CD13, CD33, CD117, CD14/CD64

(AML with minimal differentiation/ Undifferentiated leukemia)

M0

(Acute Myeloblastic L. without Maturation)

M1

(Acute Myeloblastic L. with Maturation)

M2

(Acute Promyelocytic Leukemia)

M3

(Acute Promyelocytic Leukemia) aka

Hyper granular Promyelocytic Leukemia

(Acute Myelomonocytic Leukemia)

M4

(Acute Myelomonocytic Leukemia) aka

“Naegeli” monocytic Leukemia

(Acute Monocytic Leukemia)

M5

(Acute Monocytic Leukemia) aka

Schilling’s Leukemia

(Pure Erythroid Leukemia)

M6

(Pure Erythroid Leukemia) aka

Other names:

Erythroleukemia

Erythremic Myelosis

DiGuglielmo Disease

(Acute Megakaryocytic Leukemia)

M7

MO is negative in what stain

SBB

MPO

Myelocytic origin

No maturation: >30% myeloblast

Auer rods present (fused primary granules with pencil or rod like shaped; spindle-shaped, red-purple)

Primary granules: promyelocyte

Secondary granules: myelocyte

M1

With maturation: >30% myeloblast with >10%

granulocytic component (promye- to neutrophil) 

mature forms

M2

Similar to WHO: t (8:21)

M2

With heavy granulation or Hypergranulation - abundant promyelocyte: primary granules of granulocytes

Many Auer rods in bundles called “faggot cells”

M3

WHO: t (15:17)

M3

M3 is associated with

DIC

Secondary Fibrinolysis

>20% of PB WBCs are monocytes or monocytic precursors the rest are mixture of the granulocytic cells Predominance of both myelocytic and monocytic cells at

80:20 ratio

M4

WHO: inv (16)

M4

>80% of BM elements are monocytic series; mono-, pro and monocytes

M5

WHO: t (9:11)

M5

poorly differentiated monocytic Leukemia; predominant cell is promonocyte (increased in BLASTS; >80% are mostly monoblasts)

M5a:

well differentiated; more of promonocytes and monocytes (more MATURE)

M5b:

With neoplastic Myeloblasts & Erythroblasts Cancerous cells in BM represents: >50% are erythroid cells in all stages of maturation

M6

M6 stains positive with

PAS

Predominantly Megakaryoblasts (>30%) and micromegakaryoblast

M7

M7 stains negative with

SBB

MPO

Translocation (t) and inversion (inv)

M3

AML with recurrent cytogenetic abnormalities

More mature myeblasts: produces enzymes  (+) Cytochemical stains:

MPO (peroxidase),

SBB (lipids),

CAE (enzymes; esterase)