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Autor*: S. Valníček
Description:
Boy 13 years old, AML M4 Eo
AML M4 Eo - acute myelomonocytic leukemia with 0,5-10% of immature eosinophils (non-erythroid cells counted only) in BM.
In addition to eosinophillic granules the cells contain large dark basophillic granules, typical for M4Eo.
Monocytic differentiation is often more aparent in peripheral blood (more then 5x10/9/l of monocytes).
Abnormal chromosome 16 is present inv(16) or t(16;16).
AML M4 Eo must also fulfill the AML M4 criteria (30-80% of immature granulocytes in BM, 20-80% ofnon-erythroid cells in BM must be monoblasts, promonocytes and monocytes.
Auer rods are occasionally present in myeloblasts.
Cytochemistry:
MPOX in mono-precursors negative, in more mature granulocytes is positive (minim 3%).
NSE and BE in immature monocytes mildly positive and in mature ones strongly positive.
NaF can block the NSE and BE positivity in monocytes, but not in granulocytes.
High levels of lysozyme in blood serum and urine.
Zařazení*:
AML with inv(16)(p13q22) or t(16;16)(p13;q22), (CBFbeta/MYH11)
Přílohy*:
Description: Upwards on the left and in the centre note immature eosiniphils showing double granulation i.e. eosinophilic and large basophilic granules, typical for M4 Eo.
Downwards a monocyte is seen.
Description: Myeloid and monocytic blast cells, on the right side 3 immature eosinophiles.
Note large basophilic granules in adition to eosinophilic ones in cells seen on the right..
Description: Blast cells in M4 Eo. Note 3 immature eosinophils, 2 of them with dark blue granules, typical for eosinophils of M4 Eo.
Description: Butyrat-esterase (BE) in M4 Eo.
In the centre 2 strongly positive blasts (positivity typical for monocytes), right and downwards 2 cells with weak BE positivity.
Description: The same BM with NaF block of BE. Very weak positivity of sporadic cells only.
Description: Non specific esterase (NSE) - alpha naphtyl acetate (ANAE). All cells are more or less positive.
Description: NE cytochemical reaction+NaF block: Partial, but distinct decrease in NE positivity of all leukemic cells.
Description: Myeloperoxidase reaction (MPOX). All cells , except nucleated RBCs are positive.