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Images/Videos in Hematology
1 (
); 118-119

A case of myelodysplastic syndrome with acute myeloid leukemia or excess blasts

Consultant pathologist, Polo Labs Pvt. Ltd., Mohali, Punjab, India
Corresponding author: Kriti Chauhan, Consultant pathologist, Polo Labs Pvt. Ltd., Mohali, Punjab, India.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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)[1] with a differential of acute myeloid leukemia with myelodysplasia-related changes expressing aberrant phenotypes[2] in view of paratrabecular cell aggregates showing characteristic myeloblast-like morphology.

Figure 1:: High-power view of dyspoietic changes observed in erythroid series and granulocytic series of cells marked with stars (black=neutrophil, red=erythroblasts, brown=eosinophil, green=myeloblast, and white=myelocyte) (H&E, ×400).
Figure 2:: (a) High-power view of bone marrow biopsy showing dyspoietic features in megakaryocytes (black), eosinophils (brown) and (b) paratrabecular aggregate of blast-like cells (green) (H&E, ×400).

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The authors certify that they have obtained all appropriate patient consent.

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There are no conflicts of interest.


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