Teaching cases from the Royal Marsden and St Mary's Hospitals case 28: a patient with acute leukemia with rare leukemic cells of unusual morphology.

2004 
A bone marrow aspirate was of normal cellularity. A differential count showed blasts 48.5%, promyelocytes 9.5% (including 3.5% eosinophil promyelocytes), myelocytes 1.5%, neutrophils 3%, lymphocytes 19%, monocytes 8.5%, eosinophils 2%, plasma cells 1% and red cell precursors 7%. The Myeloid : Erythroid ratio was 10 : 1. Erythropoiesis was reduced but normoblastic. The majority of blasts had the cytological features of myeloblasts with a high nucleocytoplasmic ratio, a round nucleus and prominent nucleoli; some had 1 to 2 Auer rods. A minority of blasts (5% of nucleated cells) had the feature of monoblasts with folded nuclei and more plentiful vacuolated cytoplasm with scanty granules. There was a minor population of leukemic cells with large basophilic granules (Fig. 1); these (a)
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