Acute Myeloblastic Leukemia M1

Kingdom of Saudi Arabia
Ministry of Health
Quality Assurance Program of Hematology
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A Case presentation
Acute Myeloblastic Leukemia-M1
This Case presents a challenge to differentiate M1 from M2
Although treatment is the same.
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Age 35 years/F

Clinical findings:
Dizziness, vertigo.

CBC & pbs
WBC: 5.32
Hb: 9.4
plt: 56.000

blast 60%

Microscopic examination of stained bone marrow
aspiration slides shows hypercellular bone marrow.
It is infiltrated with heterogeneous population of
blast cells with different sizes and nuclear shape,
abundant cytoplasm mostly granulated and
sometimes vacuolated. Auer rods are seen.
Atypical promyelocytes are also present in good
number. Blast population count 75% of bone
marrow nucleated cells. Normal bone marrow
series are reduced.
Conclusion M2

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Another collegue reported
this BM asp as M1: Blast 90%,
promyelocytes 1%, mature
granulocytes 6%, other cells 4%,
note: considering the promyelocytes
seen by the first collegue as
granulated blasts, and there is no
clear granulocytic series maturation.
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Immunophenotyping performed on peripheral
blood revealed the presence of CD45+
blast cells comprising 20% of ANC.
They are positive to myeloid markers
CD13, CD33, CD34, CD117, CD11c
and anti HLA-DR, while negative for
CD14,CD15, CD11b, CD41a, CD61,
CD 71, Anti Glycophorin A and most
of lymphoid markers CD10, CD2, CD3, CD4,
CD5, CD7, CD8, CD19, CD20, CD22, CD23
and IgG. Positive for CD56. Regarding
cytoplasmic markers, they showed positivity
to myeloperoxidase.
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This case is seen by Dr Ali
bin Saad Alshammary,
general Director of
laboratories and blood
banks, and Dr. Mohammad
Khair Ahmad

[urface]

but shouldn't myoblasts not have granula in their cytoplasm?