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Acute myelogenous leukemia compatible with promyelocytic leukemia
Bone Marrow, Iliac Crest
Haematoxylin & Eosin (H&E)
64 years
64-year old male with a pancytopenia of unknown etiology. Differential diagnosis: Diclofenac-induced pancytopenia. Currently progressive disease.
Markedly hypercellular (ca. 90-100%) bone marrow trephine. The hematopoietic lineages have been mostly replaced by a diffuse monotonous blastic infiltrate. Blasts are medium-sized with eccentrically localized and often bilobated nuclei.
Leukemic blasts are highlighted by strong myeloperoxidase reactivity. Staining for CD34 revealed negative results.
Acute promyelocytic leukemia is accompanied by the chromosomal translocation t(15:17)(q22;q21) in approx. 95% of cases. The retinoic acid receptor alpha (RARA) gene on 17q21 is fused with the promyelocytic leukemia (PML) gene on 15q22. Diseases with this PML-RARA fusion can be cured by all-trans-retinoic acid (ATRA) – a pharmaceutical allowing for a re-expression of genes controlling promyelocytic maturation – in combination with As203 or chemotherapy.
Kaya Veelken, University of Basel
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