A case of myelodysplastic syndrome with acute myeloid leukemia or excess blasts
How to cite this article: Chauhan K. A case of myelodysplastic syndrome with acute myeloid leukemia or excess blasts. J Hematol Allied Sci 2021;1:118-9.
A 57-year-old man presented with pancytopenia and hepatosplenomegaly. Peripheral smear revealed a leukoerythroblastic picture. Bone marrow aspirate smears revealed marked dysplasia in all three hematopoietic lineages. The morphological changes varied from hyposegmented Pelger–Huet, ring forms to gigantic flower-like forms in neutrophils. The erythroblasts showed budding yeast-like and branching tree-like nuclei [Figure 1]. Blasts and myelocytes were enormously large in size and the bespectacled nucleus of eosinophils had transformed into a telephone receiver like shape. The biopsy revealed paratrabecular aggregates of large blast-like cells having large prominent nucleoli [Figure 2] which were positive for CD117 but negative for CD34 and HLADR on both flow cytometry and immunohistochemistry. CD34 positivity was found only in 3% of the blasts scattered elsewhere. Cytogenetics for MDS revealed del(7q). Therefore, the case was diagnosed as a myelodysplastic syndrome with excess blasts-1 (2016 WHO Criteria) with a differential of acute myeloid leukemia with myelodysplasia-related changes expressing aberrant phenotypes in view of paratrabecular cell aggregates showing characteristic myeloblast-like morphology.
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