![A 46-year-old woman presented with diffuse bone pain. She had a history of acute myeloid leukemia with minimal differentiation (AML-M0) and normal karyotype diagnosed 15 months ago, achieved complete remission (CR) 1 month after beginning induction chemotherapy, and received 3 cycles of consolidation chemotherapy until 10 months before her current presentation. A complete blood count and peripheral smear at this time showed pancytopenia (hemoglobin 10.2 g/dL, white blood cells 3.8 × 109/L, platelets 67 × 109/L) and 37% blasts. The bone marrow was packed (95% cellularity) with immature myeloid cells that stained positively for CD13, CD33, CD41, CD61, and factor VIII and negatively for myeloperoxidase and CD3. Cytogenetic analysis revealed an abnormal female karyotype with 47,XX,+1,der(1;13)(q10;q10)[18]/46,XX[2] and a FLT3/TKD mutation. The aspirate showed frequent medium to large megakaryoblasts with pale blue-gray to basophilic cytoplasm, high nucleus-to-cytoplasm ratio, pseudopod formation, and cytoplasmic projections resembling budding atypical platelets (panels A-B). A diagnosis of AML-M0 relapsing as acute megakaryoblastic leukemia (AML-M7) was made. Although the patient has been receiving reinduction chemotherapy for the past 2 months, she has not achieved CR yet. / Cytoplasmic blebs and pseudopod formation are characteristic morphologic features of megakaryoblasts in AML-M7, which frequently appear in clusters mimicking metastatic tumors.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/122/15/10.1182_blood-2013-05-503581/4/m_2537f1.jpeg?Expires=1735312436&Signature=rJIv-kRy8gIZYk4-Whuyn2C4XXLYevTe9l6WENShKBri9FI~zslXrjMWdsjAVs-Z7dVs5NeUSNSMJpo6cxnnpXd3P7n6xMIrAze2jQlLkqJWHJvEYwa9at-wCPQJZA7IIoBFRSYS-sCnVzQVpHN8euoUyJxNBvgu4XUHvdhcQvpGhosgcLeCcb9L1Z3Uzsfh~iLENLmP0OUHyRhrgDl0qX556XVcmUE2LueB9UrYZxiuDcUi5sAB1IyHf8powKtC89HH2mnWeOezqqyIbVWIZW6iOf2hIfgeK~biQ-dRBYvtSsxGaFB1H4hLYbXf7-Z8g1hqy8ju~ninqWjx~e2R8Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 46-year-old woman presented with diffuse bone pain. She had a history of acute myeloid leukemia with minimal differentiation (AML-M0) and normal karyotype diagnosed 15 months ago, achieved complete remission (CR) 1 month after beginning induction chemotherapy, and received 3 cycles of consolidation chemotherapy until 10 months before her current presentation. A complete blood count and peripheral smear at this time showed pancytopenia (hemoglobin 10.2 g/dL, white blood cells 3.8 × 109/L, platelets 67 × 109/L) and 37% blasts. The bone marrow was packed (95% cellularity) with immature myeloid cells that stained positively for CD13, CD33, CD41, CD61, and factor VIII and negatively for myeloperoxidase and CD3. Cytogenetic analysis revealed an abnormal female karyotype with 47,XX,+1,der(1;13)(q10;q10)[18]/46,XX[2] and a FLT3/TKD mutation. The aspirate showed frequent medium to large megakaryoblasts with pale blue-gray to basophilic cytoplasm, high nucleus-to-cytoplasm ratio, pseudopod formation, and cytoplasmic projections resembling budding atypical platelets (panels A-B). A diagnosis of AML-M0 relapsing as acute megakaryoblastic leukemia (AML-M7) was made. Although the patient has been receiving reinduction chemotherapy for the past 2 months, she has not achieved CR yet.
Cytoplasmic blebs and pseudopod formation are characteristic morphologic features of megakaryoblasts in AML-M7, which frequently appear in clusters mimicking metastatic tumors.
A 46-year-old woman presented with diffuse bone pain. She had a history of acute myeloid leukemia with minimal differentiation (AML-M0) and normal karyotype diagnosed 15 months ago, achieved complete remission (CR) 1 month after beginning induction chemotherapy, and received 3 cycles of consolidation chemotherapy until 10 months before her current presentation. A complete blood count and peripheral smear at this time showed pancytopenia (hemoglobin 10.2 g/dL, white blood cells 3.8 × 109/L, platelets 67 × 109/L) and 37% blasts. The bone marrow was packed (95% cellularity) with immature myeloid cells that stained positively for CD13, CD33, CD41, CD61, and factor VIII and negatively for myeloperoxidase and CD3. Cytogenetic analysis revealed an abnormal female karyotype with 47,XX,+1,der(1;13)(q10;q10)[18]/46,XX[2] and a FLT3/TKD mutation. The aspirate showed frequent medium to large megakaryoblasts with pale blue-gray to basophilic cytoplasm, high nucleus-to-cytoplasm ratio, pseudopod formation, and cytoplasmic projections resembling budding atypical platelets (panels A-B). A diagnosis of AML-M0 relapsing as acute megakaryoblastic leukemia (AML-M7) was made. Although the patient has been receiving reinduction chemotherapy for the past 2 months, she has not achieved CR yet.
Cytoplasmic blebs and pseudopod formation are characteristic morphologic features of megakaryoblasts in AML-M7, which frequently appear in clusters mimicking metastatic tumors.
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