Acute Myeloid Leukemias Diagnosis in The Light of WHO Revisions And Correlation With Risk Adaptive Management; Case Discussions

Dr. Rania Medhat SeliemConsultant Hematopathologist

Head of RH Pathology Laboratory American Board in Clinical and Anatomic Pathology

American Board in Hematology

Clinical History20 Year old male presented withdizziness and easy fatigability. On exam he had hepatomegalyno lymphadenopathy or splenomegalyWBC: 101.9 103/uL, Hb:10.3 g/dL, Plt:34 103/uL

Peripheral Smear

CASE 1

Bone Marrow Aspirate

Flow Cytometry

Summary of the FCM FindingsThe blast population was positive for CD34, MPO with partial expression of CD33 and CD13. A very small subpopulation expressed CD19. The noted abnormal myeloid cells were positive for CD33, CD13 and MPO. The cells are negative for CD34, HLA-DR, CD117

CASE 2

Clinical History30 Year old male presented withfever. On exam he had hepatosplenomegalyWBC: 26.1103/uL, Hb:9.6 g/dL, Plt:83 103/uL

Peripheral Smear

Bone Marrow Aspirate

Flow Cytometry

Summary of the FCM Findings

Two blast populationsThe first population: The blasts are positive for CD33, CD13 and MPO (myeloid differentiation) The second population The blasts are positive for CD33, CD14, CD64, CD11c, CD11b and MPO (monocytic differentiation)

CASE 3

Clinical History52 Year old female presented withEpigastric pain and body aches fro one week. On exam she had no hepatomegalylymphadenopathy or splenomegalyWBC: 40 103/uL, Hb:12.5 g/dL, Plt:20,000 103/uL

Bone Marrow Aspirate

Flow Cytometry

Peripheral Smear

CASE 4Clinical History46 Year old female presented witheasy fatigability. WBC: 6.2 103/uL, Hb:8.8 g/dL, Plt:42 103/uL

Bone Marrow Aspirate

Peripheral Smear

Flow Cytometry

Summary of the FCM Findings

One population of blastsThe blasts are positive for CD33, CD13 (variable expression), CD38 and CD11b

with dim partial expression of MPO. There is partial expression of CD14 and

CD64. Very few cells express CD117 with a subpopulation expressing CD16. The blasts negative for CD34, HLA-DR

and CD7.

Bone Marrow Aspirate & PB

Clinical History17 Year old female presented withRight iliac fossa pain, no organomegaly WBC: 23.9 103/uL, Hb:9.3 g/dL, Plt:67,000 103/uL

CASE 5

Flow Cytometry

Summary of the FCM Findings

One homogenous population of blasts.

The blasts are positive for, CD33, CD64, CD11b, CD4, CD38, and CD56 with partial expression of CD117, CD14 and CD13. The

blasts are negative for CD34, HLA-DR, CD9 and CD16

Thank You!

See You At the Lecture!