CU Hemepath

Account for University of Colorado Hematopathology department. We want to share our cool cases with you. Cases our own.

[CUpathology @CU_pathology]

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[CU Hemepath @CUHemepath]

Dysplastic megakaryocytes seen with a MECOM translocation. These megakaryocytes are abnormally small, hypolobated (1-2 lobes) with widely separated nuclear lobes.

[Hubert Lau @HubertLauMD]

Does it get more classic than this? #HemePath

[CU Hemepath @CUHemepath]

@rehdam definitely on the differential. But it is a lymphoma!

[CU Hemepath @CUHemepath]

Sharing a rare/hard case for the #hemepath enthusiasts. This presented in a young adult.

Hint: note the pattern of involvement. I'll be sharing a few stains throughout the next few days.

[CU Hemepath @CUHemepath]

@jcksalex To delve deeper into this entity, I refer you to this AJSP paper from our own @ZenggangPan with comprehensive clinicopathologic & molecular characterizations + a nice comparison to ALCL.
PMID: 27740969
Pan Z, et al. Am J Surg Pathol. 2017 Jan;41(1):25-38.

[CU Hemepath @CUHemepath]

Impressively @jcksalex got it just based on morphology! Here is the ALK. This is an ALK+ Large B cell Lymphoma. The cytoplasmic granular pattern indicates that it's likely not the typical NPM::ALK fusion and rather a variant ALK fusion.

[CU Hemepath @CUHemepath]

These are pseudogaucher cells. These can be seen in many conditions including thalassemia and myeloma. This case was disseminated mycobacteria. The organisms can be seen extracellularly as negative images against the background stain. AFB was positive and PCR confirmed MAC.

[CU Hemepath @CUHemepath]

Occasionally even on the #hemepath service, you can make a diagnosis just on the touch preparation.

[CU Hemepath @CUHemepath]

Hint: Don't forget to look outside of the cells.

[CU Hemepath @CUHemepath]

@MirunaPopescu13 Close but not quite

[CU Hemepath @CUHemepath]

Remember that ring sideroblasts can be found in many reactive entities including but not limited to: lead, alcohol, isoniazid, many, many other drugs, and copper deficiency

[CU Hemepath @CUHemepath]

Sharing another #hemepath #pathboards beauty to start off Friday. Older patient with anemia. What's your ddx?

[CU Hemepath @CUHemepath]

The cytoplasmic vacuoles raises a ddx of VEXAS, MDS, copper deficiency, and other drug/toxicity related changes. The patient had undetectable levels of copper, and her counts normalized after supplementation. This was a case of copper deficiency associated anemia.

[CU Hemepath @CUHemepath]

Yes these are giant proerythroblasts aka lantern cells seen in Parvovirus B19. In patients with immunosuppression/HIV, you can see erythroid hyperplasia and HIV associated atypia, which can mimic MDS. History and NGS can be helpful!

[CU Hemepath @CUHemepath]

This person got a bone marrow biopsy for anemia. Any guesses as to the etiology? #hemepath #pathboards

[CU Hemepath @CUHemepath]

@MirunaPopescu13 Yes it certainly is. Note the cytoplasmic pattern of expression of tryptase, compared to CD117 below (membranous)

[CU Hemepath @CUHemepath]

Guess the stain