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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2768_Библиотеки_им_академика_М_И_Перельмана
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ChAPTER 18 Myelodysplastic Syndromes
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DYSERYTHROPOIESIS
177
A
FIGURE 18.1A Oval macrocytes.
C
FIGURE 18.1C Nucleated erythrocyte with abnormal
nuclear shape.
B
FIGURE 18.1B Dimorphic erythrocyte population
(PB ×500).
MORPHOLOGY: May include any or all of the
following:
Peripheral Blood:
• Oval macrocytes
• Hypochromic microcytes
• Dimorphic erythrocyte population
Bone Marrow:
• Multinucleated erythrocyte precursors
• Abnormal nuclear shapes
• Nuclear bridging in bone marrow
• Uneven cytoplasmic staining
• Ringed sideroblasts
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SECTION 4 Leukocytes
D
FIGURE 18.1D Erythrocyte precursor with partial loss
of nucleus.
E
FIGURE 18.1E Erythrocyte precursor with abnormal
nuclear shape (bilobed, with one nucleus in mitosis,
demonstrating asynchrony [BM ×1000]).
F
FIGURE 18.1F Erythrocyte precursor with three uneven
nuclei (BM ×1000).
G
FIGURE 18.1G Erythrocyte precursor with nuclear
bridging (arrow) (BM ×1000).
ChAPTER 18 Myelodysplastic Syndromes
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179
H
FIGURE 18.1H Erythrocyte precursors with uneven
cytoplasmic staining (BM ×1000).
I
FIGURE 18.1I Ringed sideroblasts are precursor RBCs
containing at least ve iron granules that circle at least
one-third of the nucleus. (iron stain, BM ×1000).
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SECTION 4 Leukocytes
DYSMYELOPOIESIS
A
FIGURE 18.2A Abnormal granulation, agranular
segmented neutrophil.
C
FIGURE 18.2C Abnormal nuclear shapes, neutrophil
with hypersegmented nucleus; also exhibits
hypogranulation.
B
FIGURE 18.2B Abnormal nuclear shapes, neutrophil
with circular (donut) nucleus.
D
FIGURE 18.2D Normal neutrophil for comparison.
ChAPTER 18 Myelodysplastic Syndromes
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181
E
FIGURE 18.2E Persistent basophilic cytoplasm in
abnormal myelocytes.
MORPHOLOGY: May include any or all of the
following:
Peripheral Blood and Bone Marrow:
• Abnormal granulation
• Abnormal nuclear shapes
• Persistent basophilic cytoplasm
• Uneven cytoplasmic staining
• Pseudo-Pelger-Huët cells (see Figure 14.1)
F
FIGURE 18.2F Uneven cytoplasmic staining with
uneven granulation. This characteristic does not
necessarily imply malignancy but is often found in MDS.
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SECTION 4 Leukocytes
DYSMEGAKARYOPOIESIS
A
FIGURE 18.3A Giant platelet.
C
FIGURE 18.3C Platelet with hypergranulation (arrow).
B
FIGURE 18.3B Platelet with hypogranulation (arrow).
D
FIGURE 18.3D Giant platelet.
ChAPTER 18 Myelodysplastic Syndromes
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183
E
FIGURE 18.3E Circulating micromegakaryocyte.
Hypogranular pseudo-Pelger-Huët cell at arrow
G
FIGURE 18.3G Abnormal nuclear shape, uneven
number of nuclei (BM ×1000).
F
FIGURE 18.3F Large mononuclear megakaryocyte
(BM ×1000).
H
FIGURE 18.3H Abnormal nuclear shapes, separate
nuclei (BM, original magnication ×1000).
MORPHOLOGY: May include any or all of the following:
Peripheral Blood:
• Giant platelets
• Platelets with abnormal granulation
• Circulating micromegakaryoctyes
Bone Marrow:
• Large mononuclear megakaryocytes
• Abnormal nuclear shapes
• Uneven number of nuclei
• Separate nuclei
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CHAPTER 19
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MATURE
LYMPHOPROLIFERATIVE
DISORDERS
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SECTION 4 Leukocytes
ature lymphoproliferative disorders frequently are derived from a single
clone of cells. Although this group of diseases involves lymphocytes, the
M
phological disease features with immunophenotyping is necessary for appropriate
recognition and classication. Only representative samples are included in this atlas.
differentiate reactive from malignant processes. See Figure 14.7 for characteristics
of reactive lymphocytes.
morphological presentation is variable. The integration of clinical and mor-
Note: Sustained absolute lymphocytosis in an adult should be investigated to
CHRONIC LYMPHOCYTIC LEUKEMIA
A
FIGURE 19.1A Small lymphocytes with smudge cells at
arrows (PB×500).
B
FIGURE 19.1B Albumin smear: same patient as
presented in Figure 19.1A (PB×500).
NOTE: Addition of albumin to blood before smear
preparation stabilizes CLL cells, decreasing the
formation of smudge cells and allows for accurate
cell classication.
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