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Recurrent AML following peripheral stem cell transplant

View larger version (168K): [in this window] [in a new window]   Figure 1. The patient is a 26-year-old male who was diagnosed in CML blast crisis in November 2005. He received induction therapy followed by a peripheral stem cell transplant from a female sibling in January 2006. Chimerism studies performed in May 2007 showed 100% of cells to be XX karyotype. He remained in remission until June 2008, when chimerism studies showed 12% of his cells then to be of XY karyotype. An attempt at bone marrow aspirate was unsuccessful; however, a marrow biopsy was obtained. The marrow was 100% cellular with distinct areas of normal hematopoiesis and areas of expanded blast populations. The first image illustrates a normal hematopoietic area. Megakaryocytes are readily identified. Both erythroid and myeloid series show terminal maturation. There is no evidence of an expanded blast population.

View larger version (161K): [in this window] [in a new window]   Figure 2. The same image at higher magnification is shown.

View larger version (179K): [in this window] [in a new window]   Figure 3. An extensive expansion of blasts was noted adjacent to the previously shown area of normal hematopoiesis. The blasts had minimal cytoplasm, irregular nuclear borders and prominent nucleoli. Mitotic figures were easily seen. Dysplastic megakaryocytes were also present. A reticulin stain (not shown) revealed marked fibrotic component.

View larger version (168K): [in this window] [in a new window]   Figure 4. The previous image is shown at a higher magnification.

View larger version (165K): [in this window] [in a new window]   Figure 5. This image shows the intersect of an area of normal hematopoiesis (bottom left) and the leukemic infiltrate (top and middle).

View larger version (175K): [in this window] [in a new window]   Figure 6. The intersect of the normal and leukemic marrow areas are evident at the higher magnification shown. Increased but scattered blasts can be seen in the area of normal hematopoiesis.

View larger version (178K): [in this window] [in a new window]   Figure 7. An immunohistochemical myeloperoxidase stain is shown. The leukemic blasts are negative; however, the area of normal hematopoiesis shows numerous myeloid lineage cells.

View larger version (158K): [in this window] [in a new window]   Figure 8. The leukemic blasts were CD34-positive on immunohistochemical staining, as shown in this image.

View larger version (71K): [in this window] [in a new window]   Figure 9. FISH analysis for XY was performed on the paraffin block to determine whether the karyotype of the blast population was male in origin, representing recurrent leukemia, or the blasts were donor in origin. The red (orange) color represents the X chromosome, and the green color represents the Y chromosome. The image shown is from the area of normal hematopoiesis and shows only green signals consistent with the female donor cells (XX).

View larger version (77K): [in this window] [in a new window]   Figure 10. The leukemic infiltrate shows both red and green signals consistent with a male karyotype. The final diagnosis was recurrent AML in a patient who had undergone successful peripheral stem cell transplant 18 months previously.

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bourreza, A. Articles by Lazarchick, J. Search for Related Content PubMed Articles by Bourreza, A. Articles by Lazarchick, J. Related Collections Stem cell/Bone marrow Related ASH-SAP Chapter Related Image Bank Image Sets Related ASH Education Book Article Social Bookmarking                   What's this?