Pocket Oncology (Pocket Notebook Series), 1st Ed.

Peripheral Blood Smears and Bone Marrow Aspirates/Biopsies

Peter Maslak

1. Normal peripheral blood: Smear contains granulocytes, a relatively uniform red cell population, and platelets.

2. Normal bone marrow aspirate: Heterogenous population with maturing elements in multiple lineages.

3. Myeloid blast with Auer rods: Immature cell with high nuclear cytoplasmic ratio and distinctive cytoplasmic inclusions.

4. Chronic myelogenous leukemia—bone marrow aspirate: Hypercellular aspirate with increased M:E ratio and eosinophilia.

5. Mast cell leukemia—bone marrow aspirate: Irregular, immature cells with metachromatic staining granules.

6. Essential thrombocythemia—bone marrow biopsy: Megakaryocytes are increased and appear in clusters.

7. Myelodysplastic syndrome—bone marrow aspirate: Dysplastic erythroid elements are increased and display nuclear cytoplasmic asynchrony.

8. Ring sideroblasts (MDS)—bone marrow aspirate with iron stain: Iron stain demonstrates abnormal localization in the perinuclear mitochondria.

9. Acute monocytic leukemia—bone marrow aspirate: Blasts appear regular with ample cytoplasm.

10. Acute promyelocytic leukemia—bone marrow aspirate: Heavy granulation obscures the nuclear cytoplasmic border.

11. Acute myeloid leukemia with myelodysplasia-related changes—bone marrow aspirate: Blasts are increased with dysplastic changes in other lineages.

12. Acute myelomonocytic leukemia—bone marrow aspirate: Marrow contains both immature monocytic and myeloid elements with characteristic baso-eosinophils.

13. Acute megakaryocytic leukemia—bone marrow aspirate: Blasts are undifferentiated with cytoplasmic blebs.

14. Pure erythroid leukemia—bone marrow aspirate: Proerythroblasts predominate the marrow.

15. Blastic plasmacytoid dendritic cell neoplasm—bone marrow aspirate: Rare disorder is classified with the myeloid leukemias.

16. Acute lymphoblastic leukemia—bone marrow aspirate: Blasts with scant cytoplasm and smooth nuclear chromatin.

17. Adult T-cell leukemia/lymphoma—peripheral blood: Characteristic “flower cells” circulate in the blood.

18. T-cell prolymphocytic leukemia—peripheral blood: Malignant cells often have indistinct nucleoli and irregular nuclear contours.

19. Sézary syndrome—peripheral blood: Cells have folded, irregular nuclei.

20. Plasma cell leukemia—peripheral blood; circulating plasma cells are often accompanied by rouleaux formation in the red blood cells.

21. Chronic lymphocytic leukemia—bone marrow aspirate: Marrow replaced by well-differentiated lymphocytes.

22. Hairy cell leukemia—bone marrow aspirate: Cells have characteristic cytoplasmic projections.

23. Multiple myeloma with Dutcher bodies—bone marrow aspirate: Sheets of plasma cells with distinctive nuclear inclusions.

24. Metastatic breast cancer—bone marrow biopsy: Tumor cells disrupt the normal marrow architecture.