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Autor*: A. Buliková
Description:
32-years old woman with mild leukocytosis (27 G/l), low platelet count (55 G/l) and anemia (Hb 92 g/l). Peripheral blood smear shows mature and immature monocytes and blasts. Bone marrow smears morphology shows acute myelomocytic leukaemia with abnormal eosinophil component. Diagnosis was supported by fluorescence in situ hybridization - in 61% cells presence of inv(16) was demonstrated, molecular genetics studies confirm CBFbeta/MYH11.
This patient has underwent chemotherapy for breast cancer since 2005 (taxotere, doxorubicine, cyclophosphamide); acute myeloid leukaemia could be classified also as therapy related.
Zařazení*:
AML with inv(16)(p13q22) or t(16;16)(p13;q22), (CBFbeta/MYH11)
Přílohy*:
Description: Two monocytes with fine nuclear chromatin and prominent with irregular nucleus and more mature grayish-blue cytoplasm with a few small vacuoles (cell at the top). 
Description: Monocytes in peripheral blood reach to 47% (absolute number 12,7G/l) at the time of diagnosis. One segmented neutrophil at 4 o'clock. 
Description: Several blasts with heterogeneous morphology, one monocyte and two eosinophils. This one at the left is really immature (promyelocyte), has a few large granules purple-violet in colour reminding basophilic granulation mixing with eosinophlic granules. Naked nuclei and damaged cells.
Description: Blasts and promonocytes, eosinophils with atypical "basophil like" granulation. One promyelocyte at 5 o' clock. Eosinophil component reaches almost 14% of nucleated bone marrow cells. 
Description: Hyper-cellular bone marrow with mixture of tumour cells of granulocytic and monocytic lineages. Two characteristic eosinophil myelocytes, that in at right has vacuolized cytoplasm. Eosinophil the mostly at right is promyelocyt with numerous purple pro-granules. 
Description: Staining of alpha naphthyl acetate esterase is strong positive in monocytic cells and rather weakly positive in granulocytic cells. 
Description: Staining of alpha naphthyl acetate esterase is blockaded by natrium fluoride (compare with previous picture) in monocytic lineage. 
Description: Staining of naftol ASC chloracetate esterase is positive in neutrophil lineage, negative in monocytic cells. In this case AML inv(16) is faintly positive reaction in abnormal eosinophils (at 5 and at 12 o'clock) - usually are eosinophils negative.