Добавил:

Sekretar kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.

Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Книга_2768_Библиотеки_им_академика_М_И_Перельмана

.pdf

Скачиваний:

Добавлен:

31.08.2026

Размер:

25 Мб

Скачать

☆

<<< < Предыдущая 5 6 7 8 9 10 11 12 13 14 15 1617 / 2917 18 19 20 21 22 23 24 25 26 27 28 29 > Следующая >>>

CHAPTER 15 Acute Myeloid Leukemia

https://t.me/medicina_free

MORPHOLOGY:

Peripheral Blood: Blasts with some maturation ± Auer rods (see Figures 15.2) Bone Marrow: Blasts, some with large azurophilic granules, perinuclear hof± Auer rods

Less than 90% of nonerythroid cells are blasts 10% or higher neutrophilic component Less than 20% monocytic component

CYTOCHEMISTRY:

Myeloperoxidase: Positive (see Figure 15.2E) Sudan Black B: Positive (see Figure 15.2F)

GENETICS:

Subset with t(8;21) is designated as AML with recurrent genetic abnormalities. In this subset, blasts are large with abundant basophilic cytoplasm, azurophilic granules, and possible perinuclear hofs.

IMMUNOPHENOTYPE:

CD13

, CD33

, CD65

, CD11b

, CD15

, HLA-DR

147

148

https://t.me/medicina_free

SECTION 4 Leukocytes

ACUTE PROMYELOCYTIC LEUKEMIA WITH PML-RARA FAB M3

FIGURE 15.4A Peripheral blood. A, Hypergranular

promyelocyte (×1000); B, Faggot cells.

FIGURE 15.4C Bone marrow ( ×1000).

FIGURE 15.4B Bone marrow ( ×500).

MORPHOLOGY:

Peripheral Blood: White blood cell count may be low

or only slightly elevated

Hypergranular abnormal promyelocytes, pink to purple

cytoplasm; nucleus may be folded or bilobed

Multiple Auer rods possible, may be in bundles,

schistocytes

Bone Marrow: Hypergranular abnormal

promyelocytes, pink to purple cytoplasm; nucleus may be folded or bilobed

± Multiple Auer rods

CYTOCHEMISTRY:

Myeloperoxidase: Strongly positive (see Figure 15.2E) Sudan Black B: Strongly positive (see Figure 15.2F)

GENETICS:

t(15;17) is sufcient for diagnosis as AML with recurrent genetic abnormalities regardless of blast/promyelocyte

‡

count.

IMMUNOPHENOTYPE:

CD13

, CD33

, CD34 , HLA-DR , CD15 , CD65 , CD117

‡

Abnormal promyelocytes are considered blast equivalents for the purpose of diagnosis.

NOTE: Acute promyelocytic leukemia may be associated

with disseminated intravascular coagulopathy.

CHAPTER 15 Acute Myeloid Leukemia

https://t.me/medicina_free

ACUTE PROMYELOCYTIC LEUKEMIA WITH PML-RARA: MICROGRANULAR VARIANT

(HYPOGRANULAR) VARIANT FAB M3

149

FIGURE 15.5A Peripheral blood ( ×1000).

MORPHOLOGY:

Peripheral Blood: White blood cell count markedly

elevated; deeply notched nuclei

Cytoplasm may appear agranular because of submicro-

scopic size of granules, which are evident with electron microscopy

Bone Marrow: Agranular promyelocytes, with deeply

notched nuclei

CYTOCHEMISTRY:

Myeloperoxidase: Strongly positive (see Figure 15.2E) Sudan Black B: Strongly positive (see Figure 15.2F)

GENETICS:

t(15;17) is sufcient for diagnosis as AML with recurrent genetic abnormalities regardless of blast/promyelocyte count.

IMMUNOPHENOTYPE:

CD13

CD15

−

, CD33

, CD65

, CD34

−

, HLA-DR

−

, CD64

, CD117

FIGURE 15.5B Bone marrow ( ×500).

FIGURE 15.5C Bone marrow ( ×1000).

NOTE: Microgranular promyelocytes can be confused

morphologically with monocyte precursors.

150

https://t.me/medicina_free

SECTION 4 Leukocytes

ACUTE MYELOMONOCYTIC LEUKEMIA

FAB M4

FIGURE 15.6A Peripheral blood ( ×1000).

NOTE: Promonocyte at arrow

FIGURE 15.6B Bone marrow ( ×500).

FIGURE 15.6C Bone marrow ( ×1000).

NOTE: Pseudopod at arrow

FIGURE 15.6D Positive naphthol-AS-D chloroacetate

esterase (specic) stain.

CHAPTER 15 Acute Myeloid Leukemia

https://t.me/medicina_free

151

FIGURE 15.6E Positive myeloperoxidase (500 ×).

(Courtesy George Girgis, CLS, IU Health).

FIGURE 15.6F Positive α-Naphthyl butyrate esterase

(×1000). (Courtesy George Girgis, CLS, IU Health).

MORPHOLOGY:

Peripheral Blood: Myeloblasts, promyelocytes, and other immature myeloid precursors

Monoblasts, promonocytes, and monocytes; frequently more mature than those seen in bone marrow ± Auer rods (see Figure 15.2B) Bone Marrow: Monoblasts have round nuclei with abundant moderate to intensely basophilic cytoplasm Possible pseudopod formations, vacuoles, and Auer rods are possible Nuclear chromatin is ne with one or more prominent nucleoli Promonocytes are delicately convoluted nucleus with ne chromatin and prominent nucleoli; cytoplasm is not

as basophilic as the monoblast and may be more obviously granulated with occasional large azurophilic granules and vacuoles

Eosinophils are increased and abnormal with many large, immature granules

CYTOCHEMISTRY:

Myeloperoxidase: Blast ≥ 3% positive (see Figure 15.2E) Specic Esterase: Naphthol-AS-D chloroacetate esterase is positive in granulocytic cells and weak in mono-

cytic cells (see Figure 15.6D)

Nonspecic Esterase:

• α-Naphthyl acetate esterase: weakly positive or absent in monocytic cells. (Figure15.6E); inhibited by NaFl (Figure15.6F)

• α-Naphthyl butyrate esterase: positive or absent in monocytic cells (see Figure 15.8D)

GENETICS:

Recurrent genetic abnormalities: not dened.

NOTE: inv(16) or t(16;16) and abnormal eosinophils are excluded from this category.

IMMUNOPHENOTYPE:

CD13

, CD33

, CD14

, CD4

, CD11b

, CD64

, CD15

, CD36

152

https://t.me/medicina_free

SECTION 4 Leukocytes

ACUTE MYELOID LEUKEMIA WITH inv(16) (13.1;q22) OR

t(16;16) (p13.1;q22); CBFB-MYH11

Acute Myeloid Leukemia With Abnormal Marrow Eosinophils

FAB M4EO

FIGURE 15.7A Peripheral blood ( ×1000).

FIGURE 15.7B Bone marrow ( ×500).

FIGURE 15.7C Bone marrow ( ×1000).

FIGURE 15.7D Bone Marrow ( ×500). Eosinophil with

immature granules (arrow) (Courtesy George Girgis, (CLS) IU Health).

CHAPTER 15 Acute Myeloid Leukemia

https://t.me/medicina_free

MORPHOLOGY:

Peripheral Blood: Myeloblasts, monoblasts, promyelocytes, and other immature myeloid precursors

Monoblasts, promonocytes, and monocytes Bone marrow ± Auer rods (see Figure 15.2B) Bone Marrow: Monoblasts have round nuclei with abundant moderate to intensely basophilic cytoplasm Possible pseudopod formations, vacuoles, and Auer rods are possible Nuclear chromatin is ne with one or more prominent nucleoli Promonodytes have delicately convoluted nucleus with ne chromatic and prominent nucleoli; cytoplasm is

not as basophilic as the monoblast and may be more obviously granulated with occasional large azurophilic granules and vacuoles

Eosinophils are increased and abnormal with many large, immature granules

CYTOCHEMISTRY:

Myeloperoxidase: Blast ≥3% positive (see Figure 15.2E) Nonspecic Esterase: Positive Specic Esterase: Weakly positive in abnormal eosinophils

GENETICS:

Recurrent genetic abnormality: inv(16).

IMMUNOPHENOTYPE:

CD13

, CD33

, CD14

, CD4

, CD11b

, CD11c

, CD64

, CD15

, CD36

153

154

https://t.me/medicina_free

SECTION 4 Leukocytes

ACUTE MONOBLASTIC AND MONOCYTIC LEUKEMIA

FAB M5

FIGURE 15.8A Peripheral blood: monoblasts

predominate ( ×1000).

FIGURE 15.8C Bone marrow showing monoblast

predominance ( ×500).

FIGURE 15.8B Peripheral blood: promonocytes

predominate ( ×1000).

FIGURE 15.8D Positive α-naphthyl butyrate esterase

(nonspecic) esterase stain.

CHAPTER 15 Acute Myeloid Leukemia

https://t.me/medicina_free

MORPHOLOGY:

Peripheral Blood: Monoblasts, promonocytes, monocytes Bone Marrow: ≤ Bone marrow cells are of granulocytic lineage

Monoblasts have round nuclei with abundant moderate to intensely basophilic cytoplasm Possible pseudopod formations, vacuoles, and Auer rods are possible Nuclear chromatin is ne with one or more prominent nucleoli. Promonocytes have delicately convoluted nucleus with ne chromatin and prominent nucleoli; cytoplasm is

not as basophilic as the monoblast and may be more obviously granulated with occasional large azurophilic

granules and vacuoles ≥ 80% have monocytic morphology; ≤20% granulocyte morphology Hint: In monoblastic leukemia, the majority of bone marrow cells are monoblasts. In monocytic leukemia, the majority of bone marrow cells are promyelocytes.

CYTOCHEMISTRY:

Myeloperoxidase: Negative (may have some weak activity in promonocytes) Nonspecic Esterase: Positive

GENETICS:

Recurrent genetic abnormality: t(9;11), common in children.

IMMUNOPHENOTYPE:

CD14

, CD4

, CD11b

, CD64

, CD68

, HLA-DR

155

156

https://t.me/medicina_free

SECTION 4 Leukocytes

ACUTE ERYTHROID LEUKEMIA

FAB M6a

(Pure Erythroid Leukemia)

FIGURE 15.9A Peripheral blood ( ×1000).

FIGURE 15.9C Bone marrow: pure erythroid

leukemia (×500).

FIGURE 15.9B Bone marrow: erythroid/myeloid

leukemia (×500).

FIGURE 15.9D Positive periodic acid–Schiff stain.

<<< < Предыдущая 5 6 7 8 9 10 11 12 13 14 15 1617 / 2917 18 19 20 21 22 23 24 25 26 27 28 29 > Следующая >>>

Соседние файлы в папке Библиотека им академика М.И. Перельмана

#
31.08.202626 Мб0Книга_2761_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202626 Мб0Книга_2763_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202625 Мб0Книга_2764_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202625 Мб0Книга_2766_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202625 Мб0Книга_2767_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202625 Мб0Книга_2768_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202625 Мб0Книга_2769_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202624 Мб0Книга_2770_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202624 Мб0Книга_2771_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202624 Мб0Книга_2773_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202624 Мб0Книга_2774_Библиотеки_им_академика_М_И_Перельмана.pdf