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Strong suspicion of a disease belonging to the category of myeloid and lymphoid neoplasms with eosinophilia and recurrent genetic abnormalities of PDGFR-alpha-, PDGFR-beta- or FGFR1-gene.
Bone Marrow, Iliac Crest
Haematoxylin & Eosin (H&E)
69 years
69-year old female patient with eosinophilia (7 G/l) since 6 months. Hepatosplenomegly.
Artificially altered and fragmented bone marrow trephine biopsy showing massive hypercellularity (nearly 100%/ packed marrow). Myelopoiesis shows impaired maturation. The amount of eosinophilic granulocytes is distinctly increased. Megacaryopoiesis is increased with grouped, cytologically atypical small and hypolobulated megacaryocytes. Erythropoiesis is dysorganised and shows macroblastic features. There is a diffuse myelofibrosis stage 2.
The immunohistochemical stain for CD 34 shows no augmentation of bone marrow blasts (1-2%), but an increased density of small vessels. The stain for mast cell tryptase shows a modest increase in inconspicuous mastcells, no signs for systemic mastocytosis.
Andrea Bodmer, University of Basel
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