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Autor*: A. Buliková
Description:
71-years old patient has come to hospital for dyspnea, massive sweat and abdominal pain in upper right quadrant. Hepatomegaly and cutaneous bleeding have been found at his clinical examination. Cell blood count examination detects leukocytosis (31G/l), severe thrombocytopenia (7G/l). Peripheral blood smear shows mature and immature cells of monocytic lineage, bone marrow contains monocytes (12.2%) , promonocytes and monoblasts (altogether 73,6%). Immunophenotyping discovers cells of fenotype CD13+14+33+34-38+DR-. Final diagnosis is acute monocytic leukaemia.
Zařazení*:
Acute monoblastic and monocytic leukaemia
Přílohy*:
Description: One segmented neutrophil and two atypical monocytes - they have more basophilic cytoplasm and lower one has obvious and large nulceoli. 
Description: Monoblasts at peripheral blood smear. Their cytoplasm is abundant, vacuolized and intensely (at right) to moderate (at left) basophilic. Nuclei are rather round with delicate chromatin and prominent nucleoli. 
Description: Two promonocytes in periheral blood. They have smaller N/C ratio, more mature chromatin and irregular shape of the nucleus when one compares them with monoblasts. 
Description: More or less mature cells of monocytic lineage form dominant population in peripheral blood. 
Description: Bone marrow smear show monoblasts and promonocytes. They represent 73,6 % of nucleated bone marrow cells. 
Description: Promonocytes, monocytes and one monoblast (at 5 o'clock). The presence of neutrophil cells can be rarely find (segmented neutrophil at 11 o'clock). Monocytic lineage represents > 80% nucleated bone marrow cells. 
Description: Vacuolated cytoplasm is characteristic sign of monoblasts and promonocytes. Erythrophagocytosis may be observed. 
Description: Pronounced phagocytosis in tumour cells. Cytoplasm of the cell in the middle is completely loaded by erythrocytes. The neighbouring cells (bellow and at left) have naked nuclei in their cytoplasm. 
Description: Mitosis in tumour cell. There are destroyed erythrocytes in the leukemic cell at 3 o'clock. 
Description: All cells belong to monocytic lineage. There is consumed segmented neutrophil in the centre cell. 
Description: Tumour cells can phagocyte one another in acute monocytic leukaemia. 
Description: Monoblasts can have deeply basophilic and vacuolized cytoplasm (two cells at right). They can even resemble Burkitt lymphoma's cells. 
Description: Monoloblast are typically myeloperoxidase negative, promonocytes may show some scattered MPOX positivity (probably larger cell at 8 o'clock; that smaller one is positive segmented granulocyte). 
Description: Monoblasts and promonocytes show intense non-specific esterase reaction. 
Description: The addition of natrium fluoride in non-specific esterase reaction blocks it's positivity in monocytic lineage (compare with previous picture).