BONE MARROW TREPHINE SEMINAR 2.0
Slide Digitization by:
Sdn Bhd
Case 1 - FSAK
77 years old gentleman, known case of Acute Myeloid Leukaemia (AML), given Ara-C and Venetoclax. First check marrow post chemotherapy for residual disease assessment.
FBC: Hb 7.1 (moderate anaemia), Platelet 38 (severe thrombocytopaenia), WBC 1.0 (severe leukopenia), ANC 0.3 (severe neutropenia).
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FBP: Occasional suspicious-looking cells are seen.
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BMA: Normocellular marrow with 27% blast cells. Suggestive of non-remission marrow.
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Trephine biopsy:
Reticulin stain - Digital Slide
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Point of discussion:
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Identification and quantitation of immature cells (monocytic lineage).
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Case 2 - HZH
15 years old boy with no known illness, presented with acute onset of weight loss and loss of appetite for 1 month.
On examination: hepatosplenomegaly and multiple enlarged lymph nodes.
FBC: Hb 10.2 (mild anaemia), Platelet 37 (severe thrombocytopaenia), WBC 1.9 (severe leukopenia), ANC 0.5 (severe neutropenia).
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FBP: Pancytopaenia. No blast or abnormal lymphoid cells are seen.
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Lymph node biopsy: Suggestive of B-cell lymphoma, unclassifiable with features intermediate in between DLBCL and Classical Hodgkin Lymphoma.
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BMA: Hypocellular marrow with trilineage hematopoiesis suppression. No evidence of lymphoma infiltration. Eosinophilic materials seen, possible gelatinous transformation.
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Trephine biopsy:
Reticulin stain - Digital Slide
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Point of discussion:
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Serous atrophy of bone marrow – How to ascertain the diagnosis?
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Case 3 - WAWO
58 years old lady with underlying hypertension, feeling unwell for 10 days (fever at night, on and off abdominal pain) associated with bruises over the bilateral upper and lower limb.
On examination: hepatosplenomegaly, 1 left supraclavicular lymph node 4x2cm (LN biopsy reported as myeloid sarcoma).
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FBC: Hb 8.7 (moderate anaemia), Platelet 6 (severe thrombocytopaenia), WBC 118 (hyperleukocytosis) with predominant neutrophils, basophils, eosinophils.
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FBP: Hyperleukocytosis with neutrophilia (no bimodal peak maturation), eosinophilia, marked basophilia (33%), 6% blast cells. Impression: TRO MPN, ? CML in accelerated phase.
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BMA: Haemodiluted, predominant neutrophils, marked basophils and 6 % blast cells. No megakaryocytes.
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IPT was sent using peripheral blood: 6% myeloblast, 27% basophils
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Trephine Biopsy
Toluidine blue - Digital Slide
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Point of discussion:
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Diffuse infiltration of immature cells in trephine biopsy, most lineage markers are negative.
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The discrepancy of blast count in FBP/BMA vs trephine biopsy (to differentiate accelerated vs blast phase, to decide treatment regime).
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Diff dx: CML in accelerated vs blast phase or AML with BCR-ABL1
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