1. Acute Myeloid Leukemias Diagnosis in The Light of WHO Revisions And Correlation With Risk Adaptive Management ; Case Discussions Dr. Rania Medhat Seliem Consultant Hematopathologist Head of RH Pathology Laboratory American Board in Clinical and Anatomic Pathology American Board in Hematology

2. Clinical History 20 Year old male presented with dizziness and easy fatigability. On exam he had hepatomegaly no lymphadenopathy or splenomegaly WBC: 101.9 10 3 /uL, Hb:10.3 g/dL, Plt:34 10 3 /uL Peripheral Smear CASE 1

3. Bone Marrow Aspirate

4. Flow Cytometry

5. Summary of the FCM Findings The blast population was positive for CD34, MPO with partial expression of CD33 and CD13. A very small subpopulation expressed CD19. The noted abnormal myeloid cells were positive for CD33, CD13 and MPO. The cells are negative for CD34, HLA-DR, CD117

6. CASE 2 Clinical History 30 Year old male presented with fever. On exam he had hepatosplenomegaly WBC: 26.110 3 /uL, Hb:9.6 g/dL, Plt:83 10 3 /uL Peripheral Smear

7. Bone Marrow Aspirate

8. Flow Cytometry

9. Summary of the FCM Findings Two blast populations The first population: The blasts are positive for CD33, CD13 and MPO (myeloid differentiation) The second population The blasts are positive for CD33, CD14, CD64, CD11c, CD11b and MPO (monocytic differentiation)

10. CASE 3 Clinical History 52 Year old female presented with Epigastric pain and body aches fro one week. On exam she had no hepatomegaly lymphadenopathy or splenomegaly WBC: 40 10 3 /uL, Hb:12.5 g/dL, Plt:20,000 10 3 /uL

11. Bone Marrow Aspirate

12. Flow Cytometry

13. Peripheral Smear CASE 4 Clinical History 46 Year old female presented with easy fatigability. WBC: 6.2 10 3 /uL, Hb:8.8 g/dL, Plt:42 10 3 /uL Bone Marrow Aspirate Peripheral Smear

14. Flow Cytometry

15. Summary of the FCM Findings One population of blasts The blasts are positive for CD33, CD13 (variable expression), CD38 and CD11b with dim partial expression of MPO. There is partial expression of CD14 and CD64. Very few cells express CD117 with a subpopulation expressing CD16. The blasts negative for CD34, HLA-DR and CD7.

16. Bone Marrow Aspirate & PB Clinical History 17 Year old female presented with Right iliac fossa pain, no organomegaly WBC: 23.9 10 3 /uL, Hb:9.3 g/dL, Plt:67,000 10 3 /uL CASE 5

17. Flow Cytometry

18. Summary of the FCM Findings One homogenous population of blasts. The blasts are positive for, CD33, CD64, CD11b, CD4, CD38, and CD56 with partial expression of CD117, CD14 and CD13. The blasts are negative for CD34, HLA-DR, CD9 and CD16

19. Thank You! See You At the Lecture!