The Hematologist

May-June 2019, Volume 16, Issue 3

An Older Man With Cytopenias and Seemingly Normal-Looking Marrow

Benjamin Kaumeyer, MD Fellow
The University of Chicago, Chicago, IL
Daniel A. Arber, MD Professor and Chair, Department of Pathology
University of Chicago, Chicago, IL
Girish Venkataraman, MD Editor in Chief, ASH Image Bank; Medical Director, Immunohistochemistry; Associate Professor, Department of Pathology
The University of Chicago Medicine, Chicago, IL

Published on: April 10, 2019

A 71-year-old man was diagnosed seven years ago with a hematologic malignancy that was successfully treated with chemotherapy and determined to be in complete remission. He later presented in clinic with mild fatigue. A complete blood count with differential is performed.

White blood cell count was 2.2 × 103/μL; hemoglobin, 14.5 g/dL; and platelet count, 77 × 103/μL. Differential test revealed a neutrophil count of 52 percent; lymphocytes, 43 percent; monocytes, 2 percent; eosinophils, 2 percent; and basophils, 0 percent.

A bone marrow biopsy was performed to further evaluate the patient. The images shown here are the bone marrow core biopsy with hematoxylin and eosin (H&E; Figures 1 and 2) staining, CD20 (Figure 3) and CD11c (Figure 4) immunohistochemistry on core biopsy, and representative flow cytometry plots (Figures 5 and 6). Additionally, next-generation sequencing was performed on the bone marrow biopsy and detected a BRAFV600E mutation.

A bone marrow core biopsy with H&E staining

Bone marrow core biopsy with H&E staining.


A bone marrow core biopsy with H&E staining

Bone marrow core biopsy with H&E staining.


Core biopsy showing CD20 immunohistochemistry

CD20 immunohistochemistry on core biopsy.


Core biopsy showing CD11c immunohistochemistry

CD11c immunohistochemistry on core biopsy.


Representative flow cytometry plots

Representative flow cytometry plots.


Representative flow cytometry plots

Representative flow cytometry plots.

 

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