Monday, April 02, 2012

Bone marrow trephine from last August

Date Referral Received: 19/07/2011 13:00:00
Date Referral Sent: 19/07/2011 00:00:00

Additional Clinical Information: MPN

Diagnosis (1): Consistent with Myeloproliferative disorder

Morphology [M]
Lab Accession Number: 11B0906711
Bone Marrow Word Processed:
Eric AVEBURY - DOB: 29/09/28 - D442931
Indication: Previous MALT lymphoma of lung, treated with surgery only. Noted thrombocytosis. MPL on PB positive. BM to assess MPN.
FBC (19/07/11): Hb 10.4, WBC 6.2, neut 3.8, plat 599
Site of Sample : Right posterior iliac crest
Particles : Multiparticulate
Cellularity : Hypercellular particles and trails
Myelogram : ~
BL: 2% Pro: 15% My: 17% Me: 19%
Neut: 31% Ly: 6% PC: 1% Eryth: 9%
M:E Ratio : 9
Erythropoiesis : Relatively decreased, normal maturation
Granulopoiesis : Increased, mildly dysplastic
Blast cells : Not increased
Lymphocytes : Normal numbers and morphology
Plasma cells : Normal numbers and morphology
Megakaryocytes : Increased in number, abnormally large with abnormal hyperchromatic chromatin.
Conclusion : Consistent with MPN.

Reported by : F.Pinto, Haem Registrar
Validating Consultant : R.Ireland

Immunophenotyping [IP]
Lab Accession Number: 11H0003005
Sample Type: Bone Marrow
Lab Comment:
Laboratory Comments
Results from a gate representing approx. 90% of TNC's. No immunophenotypic evidence of excess CD34+ myeloid progenitors.

Consultant Comments
Multiparticulate. Hypercellular particles and trails. Megakaryocytes increased in number and very abnormal - large, with abnormal
hyperchromatic nuclei. No excess of blasts by morphology or immunophenotyping. Consistent with MPN. pp Dr Robin Ireland

Cytogenetics [CY]
Cytogenetics Karyotype: 46,XY [8]
Cytogenetics Result: ONLY eight metaphase cells available for analysis, insufficient for complete analysis. No clonal abnormalities detected.
NB This sample had a low white cell count.

Molecular1 Analysis [MA1]
Report Comment: Whole sample stored. Sample already tested under IOG reference (IOG-11-6033951).

Histology [H]
Lab Accession Number: 11S0010916
Histology Report:
Bone marrow trephine.
A core of bony tissue measuring 10mm in length together with multiple fragments of haemorrhagic material which measure in aggregate
A1 M (1) All levels retic decal
The bone marrow trephine shows increased cellularity (70-80%) with all three haemopoietic cell lines represented. There is increase in number
of myeloid series but there is maturation to neutrophils. There is increased number of pleomorphic megakaryocytes with marked enlargement,
nuclear atypia and clustering around sinusoids and in paratrabecular locations. Few normoblasts are present.
Immunohistochemistry with CD34 shows no blasts. CD61 highlighted the clustered and abnormal megakaryocytes. CD117 is positive in 5% of
the cells including mast cells and erythroblasts. p53 is negative.
The reticulin is increased (grade 2).
The appearances are consistent with myeloproliferative neoplasm (MPN) although some features would favour myelodysplastic syndrome/
myeloproliferative neoplasm (MPD/MDS).
Bone marrow trephine: Consistent with myelodysplastic syndrome/ myeloproliferative neoplasm (MPD/MDS).

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