CWM Hospital Fiji School of Medicine Depts' of Medicine

1
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 28/2/2002

• Acute Myeloid Leukemia AML-M3

2
History

• 32 Year Fijian Female admitted to AE
• Left shoulder swelling and pain, deteriorating
  consciousness.
• Died on the same day, post mortem examination
  showed massive intraventricular hemorrhage,
  bleeding into mediastinum and muscles of left
  shoulder.
• Blood counts showed markedly elevated WBC counts,
  low platelets RBC.

3
Blood Smear

• Increased WBC, large cells.

4
Blood Smear

• Large blast cells predominate, no normal WBC seen
  here.
• Irregular folded nucleus, some kidney shaped
  moderate cytoplasm.

5
Blood Smear

• Blasts show many cytoplasmic granules
• Some blasts show needle shaped inclusions Auer
  rods.

6
Blood Smear

• Some blasts show needle shaped inclusions Auer
  rods.
• Note Crenated or Spinous irregular RBC is due to
  processing artefacts.

7
Blood Smear

• Some show granules and others show needle shaped
  inclusions Auer rods.
• Note Crenated or Spinous irregular RBC is due to
  processing artefacts.

8
Blood Smear

• Some blasts show granules
• Some blasts show needle shaped inclusions Auer
  rods.

9
Discussion

• Features seen
• Large blasts, large irregular open nucleus,
  prominent multiple nucleoli, and pink granular
  cytoplasm
• many blasts show- Auer rods.
• Acute Myeloid Leukemia Promyelocytic (AML-M3)
• Special stains and further study ?? (post
  mortem)

10
AML-M3 / Promyelocytic Leuk.

• 10 of AML are Promyelocytic (M3)
• DIC Hemorrhage - very common due to
  fibrinolysis by enzymes of promyelocyte granules.
  (Peroxidase positive)
• Both skin, mucosa and internal bleeds.
• Thrombocytopenia is usually moderate.
• Plenty of primary myeloid granules in cytoplasm,
  granules join to form Auer rods.

11
AML-M3 / Promyelocytic Leuk.

• 1-10 of blasts show crystal cytoplasmic
  inclusions of primary myeloid granules Auer
  Rods. Some blasts may show bundles of Auer rods
  known as Faggot cells.
• 20 cases show few or no granules known as
  Microgranular variant (AML - M3v)
• Strong positive staining by Sudan black and
  myeloperoxidase stain suggests myeloid nature of
  blasts, (lymphoid blasts do not show staining).