Pathology
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Atlas of Bone Marrow pathology
Mojmir Moulis, Josef Feit et al.
Index
Contents
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+ Introduction
+ Using this atlas
+ Conditions of using this atlas
+ Technical notes
+ Hardware
+ Software
+ How to use the atlas
+ Navigating through the text pages
+ Controlling the pictures
+ Logos and labels
+ What will you need to use the atlas
+ Bugs, problems
+ Netscape
+ Microsoft Internet Explorer
+ Some other Internet resources concerning dermatopathology and pathology
+ Support
+ Support
+ Bone Marrow Pathology
+ Bone Marrow Examination
+ Bone Marrow Examination
+ Histological evaluation of the trephine biopsy core
+ Normal bone marrow
+ Bone Marrow Cellularity
+ Hematopoiesis
+ Non-tumorous Lesions of Bone Marrow
+ Reactive Hematopoietic Changes
+ Erythroid hyperplasia
+ Myeloid Hyperplasia
+ Eosinophilia
+ Increased Number of Megakaryocytes
+ Bone Marrow Hypoplasia and Aplasia
+ Aplastic Anemia
+ Pure red cell aplasia
+ Agranulocytosis
+ Amegakaryocytic thrombocytopenia
+ Anemias
+ Posthemorrhagic anemias
+ Acute Posthemorrhagic Anemia
+ Chronic Posthemorrhagic Anemia
+ Megaloblastic Anemia
+ Sideropenic Anemia
+ Chronic Kidney Disease Anemia
+ Anemias of Chronic Disorders
+ Hemolytic Anemias
+ Other anemias
+ Stromal Reaction and Bone Marrow Inflammation
+ Reactive lymphocytosis, benign lymphocytic aggregates
+ Reactive Plasmacytosis
+ Granulomas
+ Hemophagocytic Syndrome
+ Storage Diseases (Thesaurismosis)
+ Gaucher's Disease
+ Niemann–Pick Disease
+ Bone marrow tumorus diseases
+ Myelodysplastic Syndrome (MDS)
+ Refractory Cytopenia with Unilineage Dysplasia (RCUD)
+ Refractory Anemia with Ringed Sideroblasts (RARS)
+ Refractory Cytopenia with Multilineage Dysplasia (RCMD)
+ Refractory Anemia with Excess Blats (RAEB)
+ MDS with Isolated 5q Deletion (5q-syndrome)
+ Myelodysplastic Syndrome Unclassified (MDS NOS)
+ Myeloproliferative neoplasms
+ Polycythemia Vera (PV)
+ Essential Thrombocythemia (ET)
+ Primary Myelofibrosis (PMF)
+ Chronic Myeloid Leukemia (CML)
+ Chronic Neutrophilic Leukemia (CNL)
+ Chronic Eosinophilic Leukemia (CEL)
+ Mastocytosis
+ MPN unclassifiable (MPN-U)
+ Myelodysplastic-myeloproliferative diseases (MDS/MPD)
+ Chronic Myelomonocytic Leukemia (CMML)
+ Atypical Chronic Myeloid Leukemia (aCML)
+ Juvenile Myelomonocytic Leukemia (JMML)
+ Myelodysplastic-Myeloproliferative Diseases Unclassifiable
+ Acute Myeloid Leukemia (AML)
+ Lymphoproliferative Disorders
+ Acute Lymphoblastic Leukemia (ALL)
+ Chronic Lymphocytic Leukemia (CLL)
+ Prolymphocytic Leukemia (PLL)
+ Hairy cell leukemia (HCL)
+ Plasma Cell Neoplasms
+ Plasma Cell (Multiple) Myeloma
+ Solitary Plasmocytoma
+ Monoclonal Gammapathy of Undetermined Significance (MGUS)
+ Other Lymphoproliferative Diseases
+ Histiocytoses
+ Histiocytosis X (Langerhans Cell Histiocytosis)
+ Letterer-Siwe Histiocytosis
+ Hand-Schüller-Christian Histiocytosis
+ Eosinophilic Granuloma
+ Histiocytic Sarcoma
+ Metastatic Infiltration of the Bone Marrow
+ Posttheraupetic a Posttransplant Hematopoietic Changes
+ Posttheraupetic Hematopoietic Changes
+ Restitution of Hematopoiesis
+ Persistent Alterations of Hematopoiesis.
+ Posttransplant Alterations of Hematopoiesis
+ Pathology of the Bone
+ Other Disorders
Acute Myeloid Leukemia (AML)
Introduction

Clonal expansion of myeloid blasts in bone marrow, peripheral blood or other organs.

Etiology
  • viral infections
  • ionizing radiation
  • cytotoxic chemotherapy
  • benzene
  • and other
Clinical signs
  • most often elderly patients (median is 60 years)
  • incidence 10/100.00
  • anemia
  • thrombocytopenia
  • leukocytosis with neutropenia (or leukopenia)
  • infections
  • and other
Classification
  • FAB 1982 — purely morphological classification
  • WHO 2008 — takes cytogenetic abnormalities and prognosis into account (besides morphology)

FAB classification:

  • M0 — Minimally differentiated myeloblastic leukemia
  • M1 — Myeloblastic leukemia without maturation
  • M2 — Myeloblastic leukemia with maturation
  • M3 — Promyelocytic leukemia
  • M4 — Myelomonocytic leukemia
  • M5a — Monoblastic leukemia
  • M5b — Monocytic leukemia
  • M6 — Erythroid leukemia
  • M7 — Megakaryoblastic leukemia

WHO classification:

  • AML with recurrent genetic abnormalities (usually balanced translocations, relatively favourable prognosis, high complete remission rate)
  • AML with multilineage dysplasia (worse prognosis)
  • therapy-related AML (cytotoxic chemotherapy or radation therapy, refractory to antileukemic therapy, short median survival time)
  • AML not otherwise categorized (morphologic clasification similar to the FAB system)
  • AL with double differentiation (bilinear, biphenotypic)
Histology

Bone marrow is markedly hypercellular, sometimes hypocellular (especially therapy-related AML), myelopoiesis is usually markedly increased with a differentiation arrest and increased myeloblast (monoblast) levels above 20%. Megakaryocytes and erythropiesis are residual (except M6 and M7), M7 leukemia causes significant fibrosis.

Most common sites of infiltration are the spleen, liver, lymph nodes and other, however significant organomegaly is uncommon. Sometimes tumoriform lesions (myelosarcoma) may be found.

Secondary symptoms: bleeding, infections, anemia.

Pictures

Acute myeloid leukemia, hypoplastic, bone marrow: Hypoplastic acute myeloic leukemia, HE 100x (73112) Hypoplastic acute myeloic leukemia, PAS 100x (73113)

Acute meyloid leukemia, kidney, infiltration into the glomerulus: Kidney in acute myeloic leukemia, HE 100x (72796)