2. FAB Classification (French, American, British)

3. Acute Myelocytic Leukemia (FAB M1)
Univ of Minn, Hematography case 4 AML, FAB M1

4. Auer Rod

5. AML (M2)
M2: some promyelocytic differentiation, maybe a few Auer rods; * t(8;21) is distinctive (newly-discovered gene on 21 named AML1: Proc. Nat. Acad. Sci. 88: 10413, 1991; see this article for information about other translocations)

6. Acute Promyelocytic Leukemia (M3)
M3: very granular promyelocytes, often many Auer rods, DIC (* from annexin II on the surfaces that activates plasmin: NEJM 340: 944, 1999); * t(15;17) and * t(11;17) are distinctive, and (KNOW:) involve the vitamin A receptor (Blood 77: 1418 & 1657, 1991; Proc. Nat. Acad. Sci. 91: 1178, 1994).

7. Promyelocytic Leukemia

8. Promyelocytes

9. Acute Myelomonocytic Leukemia (M4)
M4: myeloid and monocytic differentiation

10. Acute Monocytic Leukemia (M5a)
M5a is monoblastic M5: monocytic differentiation only; * t(9;11)(p22;q23); 9p22 is beta-interferon receptor, while 11q23 is the MLL (myeloid-lymphoid leukemia gene; common in infant and adult leukemias, though not childhood leukemias (Proc. Nat. Acad. Sci. 88: 10735, 1991; Blood 94: 283, 1999)

11. Acute Monocytic Leukemia

12. AMoL (M5b)
Univ of Minn, Hematography case 9 Acute Monocytic Leuk with maturation, FAB 5b

13. Erythroleukemia (M6)
Univ of Minn, Hematography case 27 Erythroleukemia AML FAB M6) M6: features of red cell precursors predominate; "Di Guglielmo's erythroleukemia" (* future pathologists: look for d-PAS-positive chunks in the cytoplasm)

14. Erythroleukemia, Bone Marrow
Univ of Minn, Hematography case 27 Erythroleukemia (AML FAB M6)

15. Acute Megakaryocytic Leukemia (M7)
M7: platelet markers; acute marrow fibrosis (* PDGF effect; reticulin); acute megakaryoblastic leukemia is a childhood leukemia (Am. J. Clin. Path. 122-S: S33, 2004).

16. Megakaryoblasts (M7)

17. CML
Chronic Myelogenous Leukemia: A myeloproliferative disorder. A high power view from the same patient showing all stages of maturation and increased platelets.

18. CML
Imperial College London In this disease there is an increase in mature polymorphs (neutrophils, eosinophils, basophils) and their precursors in the peripheral blood. All the types of granulocyte precursor which are normally seen in the bone marrow are present in the blood. This slide shows myeloblasts ('blast cells') (purple arrows), promyelocyte (blue arrows), a myelocyte (green arrow), cells intermediate between myelocytes and mature neutrophils (metamyelocyte, red arrow ) and mature neutrophils

19. CML
Univ of Minn, Hematography case 17 CML

20. CGL
Crookston collection.

21. Chronic Myelomonocytic Leukemia

22. CGL to AML (Blast Crisis)
Crookston collection. Chronic Granulocytic Leukemia transforming into Acute Myeloid Leukemia.

23. Chronic Eosinophilic Leukemia
Univ of Minn, Hematography case 35 Chronic eosinophilic leukemia (hypereosinophilic syndrome)

24. Acute Lymphoblastic Leukemia (FAB L1)
Univ of Minn, Hematography case 6 B Cell ALL, FAB L1 L1: small cells, scant basophilic cytoplasm with variable vacuoles, small nucleoli, regular nuclear shape, homogenous chromatin

25. Acute Lymphoblastic Leukemia (L1)
Scant cytoplasm and prominent nucleoli

26. ALL (L2)
L2: large heterogeneous cells with moderate cytoplasm, often intensely basophilic, variable vacuoles; large nucleoli, irregular nuclear shape with clefting and indentation, large nucleoli, variable nuclear chromatin

27. Burkitt’s Lympohoma (ALL L3)
Univ of Minn, Hematography case 31 Burkitt lymphoma/Burkitt cell leukemia L3: medium to large homogenous cells with moderate cytoplasm that is intensely basophilic with prominent cytoplasmic vacuoles; at least one prominent nucleoli (may be 2-4), round to oval nucleus, finely stippled homogenous chromatin, cytologically identical to Burkitt’s and Burkitt’s like lymphoma (small noncleaved); has mature phenotype (i.e. expresses surface immunoglobulin); fat vacuoles are Sudan black+, Oil red O+, PAS -; cytoplasm is methyl green-pyronine positive

28. Burkitt’s Lymphoma (FAB L3)
Acute Lymphoblastic Leukemia-L3/Burkitt's lymphoma: High power of bone marrow aspirate showing the large lymphoid blasts of ALL-L3 or Burkitt's Lymphoma with high nuclear to cytoplasmic ratio, dark-blue cytoplasm, and small lipid-containing vacuoles in the cytoplasm and over the nucleus. ALL-L3 and Burkitt's are the same disease, both are highgrade B cell malignancies. WBC morphology: The abnormal cells are medium sized with rounded to slightly irregular nuclei, condensed chromatin, and one or two distinct nucleoli. There is a moderate amount of deeply basophilic cytoplasm. Some cells contain prominent vacuoles, which at times overlay the nucleus. (FAB ALL L3)

29. Prolymphocytes circulating in the peripheral blood of a patient with PLL have a prominent nucleus (MacNeal Tetrachrome 1000x)
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30. Drawing of Chronic Lymphocytic Leukemia
Note monotonous sheets of mature lymphocytes and smudge cells.

31. CLL
Univ of Minn case 34 B-cell chronic lymphocytic leukemia/ small lymphocytic lymphoma (B-cell CLL/SLL)

32. CLL

33. CLL

34. Multiple Myeloma- Cluster of plasma cells in the bone marrow
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35. Rouleaux Fomation

36. This is a bone marrow aspirate from a patient with multiple myeloma showing the abnormal accumulation of malignant plasma cells
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37. This is a bone marrow aspirate from a patient with multiple myeloma showing the abnormal accumulation of malignant plasma cells
Copyright ©2002 American Society of Hematology. Copyright restrictions may apply.

38. Plasma Cell Leukemia

39. Flame Cells: These are plasma cells with vermillion-staining glycogen-rich overstuffed fibrils
Flame Cells: These are plasma cells with vermillion-staining glycogen-rich overstuffed fibrils. Although these cytoplasmic features are suggestive of neoplastic plasma cells, they can also be found in reactive cells as well. They are also thought to be heavily associated with IgA myelomas, however they can also be associated with IgG, and IgM myeloma.
Copyright ©2006 American Society of Hematology. Copyright restrictions may apply.

40. Flame Cell IgA Myeloma

41. High-power view of these plasma cells reveals crystalline inclusions produced by precipitation of immunoglobulin

42. Mott cells have a cytoplasm filed with Russell bodies

43. Waldenstrom’s Macroglobulinemia
Rouleaux and plasmacytoid lymphs

44. Hairy Cell Leukemia
Univ of Minn, Hematography case 3

45. Hairy Cell
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46. Hairy Cells = TRAP Cells
The peripheral blood smear reveals medium-sized lymphoid cells with delicate cytoplasmic projections. The nuclei are oval, slightly indented and the chromatin pattern has a "lacelike" appearance. The pale-blue cytoplasm has a "fluffy" texture and the cell border is irregular. The cytochemical stains demonstrate acid phosphatase activity resistant to inhibition by tartaric acid ("TRAP positivity"). These morphologic features and cytochemical findings are characteristics of Hairy Cell Leukemia (HCL).

47. Hairy cell leukemia, bone marrow aspirate, Wright Giemsa stain - Mononuclear cells with abundant cytoplasm and membrane projections
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48. Hairy cell leukemia, peripheral blood, Wright-Giemsa stain - Mononuclear cells with lobated nuclei, pale cytoplasm and membrane projections
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49. Sezary Syndrome (Mycosis Fungoides)
Univ of Minn, Hematography case 7

50. Sezary Cell
Clefted nucleus, Butt cell.

51. Sezary Cell (Cleft nucleus)
Sezary Cell with cleft nuclei

52. CLL 1993- many mature lymphs, few smudge cells
CLL 7/94- many smudge cells
CLL- another case, nearly 100% lymphs
ALL (yellow label)- Lymphoblasts, large nucleoli
ALL 10/94- large number of small lymphoblasts
Plasma Cells- unknown diagnosis, plasma cells are present
(Review) Hairy Cell- hairy cells
Sezary Syndrome- lymphoid cells with cleft nuclei
CML 1,2,3- several cases (3 different slides)
CML 10% basophils- increase basophils in CML
PGL- progranulocytic (promyelocytic) leukemia
Blasts with Auer Rods- AML with auer rods
Blasts 3/97- another case of AML
Untreated Acute Leuk- AML?
Blasts- very high WBC with blasts
AMML-acute myelomonocytic leukemia.blasts with monocytic character