![A 30-year-old male presented with fever and dyspnea for 2 weeks. Apart from pallor, there were no other physical findings. Complete blood count showed hemoglobin 57 g/L, white cell count 13 × 109/L, and platelet count 22 × 109/L. Peripheral blood smear showed 34% blast cells and dysplastic granulocytes exhibiting reduced granulation and pseudo–Pelger-Huet neutrophils (red arrows; panels B and C). Auer rods were confirmed not only in the blast cell (blue arrows; panels B and C) but also within the dysplastic granulocyte (black arrow; panel A). Bone marrow was a dry tap, whereas the trephine section revealed diffuse infiltration with blast cells. Peripheral blood immunophenotyping by flow cytometry showed CD34+ blast cells expressing the myeloid markers CD13, CD33, CD117, and MPO and absence of B- and T-cell markers. Conventional cytogenetic studies showed a loss of the Y chromosome in all karyotyped cells. Based on these findings, diagnosis of acute myeloid leukemia (AML) was made. The patient received induction chemotherapy with daunorubicin/cytarabine (7+3) and showed good clearance of blast cells on his day 14 marrow aspirate. / This is a rare and unique case of AML with the characteristic presence of Auer rods in myeloblast and dysplastic granulocyte in association with loss of the Y chromosome. The loss of the Y chromosome is widely reported in myeloid malignancies, whereas presence of Auer rods in mature and dysplastic granulocytes is rare and has been described in AML with maturation [t(8;21)]. Presence of Auer rods in AML is associated with good prognosis, whereas its significance in dysplastic granulocyte has yet to be determined.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/124/7/10.1182_blood-2014-05-575118/5/m_998f1.jpeg?Expires=1722347402&Signature=fIl1icRQ-42qRBV7OItkIgCr4~CEhxYleSVJr~Lv4iH2qypNRNsXrOdiII2mAvIdmhjXTOEV-mQpQx9d52sf-zcOxaPPCzJCpD3bN0XSMMkSJXM1aXkgnlpmCdeYZ8gLNLZZ2DrkVasO0LkeVSWsZ8vCjMMWCF-QywcotE3yzOGzcURDCkAIn~X82SWVhzVKt-jTcZ3xadbQMerJ9SansoRkuHKhbJQ39Cf~1Wphd9Oo99591ghc6nsGBxVDKprcdr4lFTwJ3ulcCebn6lBDpS2IuN7Rrvp64LdBau7Yrxl5ipYLVHcYU4mCYhuq74H9TQsJyPNAKDNnvyWxayAyCw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 30-year-old male presented with fever and dyspnea for 2 weeks. Apart from pallor, there were no other physical findings. Complete blood count showed hemoglobin 57 g/L, white cell count 13 × 109/L, and platelet count 22 × 109/L. Peripheral blood smear showed 34% blast cells and dysplastic granulocytes exhibiting reduced granulation and pseudo–Pelger-Huet neutrophils (red arrows; panels B and C). Auer rods were confirmed not only in the blast cell (blue arrows; panels B and C) but also within the dysplastic granulocyte (black arrow; panel A). Bone marrow was a dry tap, whereas the trephine section revealed diffuse infiltration with blast cells. Peripheral blood immunophenotyping by flow cytometry showed CD34+ blast cells expressing the myeloid markers CD13, CD33, CD117, and MPO and absence of B- and T-cell markers. Conventional cytogenetic studies showed a loss of the Y chromosome in all karyotyped cells. Based on these findings, diagnosis of acute myeloid leukemia (AML) was made. The patient received induction chemotherapy with daunorubicin/cytarabine (7+3) and showed good clearance of blast cells on his day 14 marrow aspirate.
This is a rare and unique case of AML with the characteristic presence of Auer rods in myeloblast and dysplastic granulocyte in association with loss of the Y chromosome. The loss of the Y chromosome is widely reported in myeloid malignancies, whereas presence of Auer rods in mature and dysplastic granulocytes is rare and has been described in AML with maturation [t(8;21)]. Presence of Auer rods in AML is associated with good prognosis, whereas its significance in dysplastic granulocyte has yet to be determined.
A 30-year-old male presented with fever and dyspnea for 2 weeks. Apart from pallor, there were no other physical findings. Complete blood count showed hemoglobin 57 g/L, white cell count 13 × 109/L, and platelet count 22 × 109/L. Peripheral blood smear showed 34% blast cells and dysplastic granulocytes exhibiting reduced granulation and pseudo–Pelger-Huet neutrophils (red arrows; panels B and C). Auer rods were confirmed not only in the blast cell (blue arrows; panels B and C) but also within the dysplastic granulocyte (black arrow; panel A). Bone marrow was a dry tap, whereas the trephine section revealed diffuse infiltration with blast cells. Peripheral blood immunophenotyping by flow cytometry showed CD34+ blast cells expressing the myeloid markers CD13, CD33, CD117, and MPO and absence of B- and T-cell markers. Conventional cytogenetic studies showed a loss of the Y chromosome in all karyotyped cells. Based on these findings, diagnosis of acute myeloid leukemia (AML) was made. The patient received induction chemotherapy with daunorubicin/cytarabine (7+3) and showed good clearance of blast cells on his day 14 marrow aspirate.
This is a rare and unique case of AML with the characteristic presence of Auer rods in myeloblast and dysplastic granulocyte in association with loss of the Y chromosome. The loss of the Y chromosome is widely reported in myeloid malignancies, whereas presence of Auer rods in mature and dysplastic granulocytes is rare and has been described in AML with maturation [t(8;21)]. Presence of Auer rods in AML is associated with good prognosis, whereas its significance in dysplastic granulocyte has yet to be determined.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org.
This feature is available to Subscribers Only
Sign In or Create an Account Close Modal