Quando l’apparenza inganna: un caso di leucemia acuta con imponente vacuolizzazione dei blasti
Laboratorio Analisi Ospedale Versilia, Settore di ematologia, coagulazione e citofluorimetria, Lido di Camaiore (LU)
Appearance can be deceptive: a case of acute leukemia with marked vacuolation of blasts
A 69-year-old female, suffering from myelodysplastic syndrome, is admitted to the hospital because of worsening of anemia and thrombocytopenia. The blood count confirms anemia (hemoglobin 97 g/L) and thrombocytopenia (platelets 43×109/L) At the optical microscopy 87% blast cells are observed; these are characterized by numerous cytoplasmic vacuoles, mimicking an acute lymphoid leukemia. A similar finding is obtained in myeloaspirate smears. By means of 6-color immunophenotyping, blast cells appear to be positive for CD13, CD33, CD34, CD117, CD38, CD45RA, CD71, myeloperoxidase, and partially positive for CD235a. The positivity for myeloperoxidase is confirmed by standard cytochemistry. Acute myeloid leukemia with myelodysplasia-related changes is diagnosed. This case shows that marked vacuolation of blasts, although more frequent in cases of B-cell acute leukemia, may be present in sporadic cases of acute myeloid leukemia.