Figure 3.
Figure 3. Each FAB category contains a mixture of leukemic cells of different lineages. (A) Hematoxylin and eosin (left) and NPM staining (right, APAAP; hematoxylin counterstain, ×1000) of an AML-M4, showing nuclear plus cytoplasmic NPM expression only in myeloid and monocytic cells. The arrow indicates the nucleus-restricted positivity in endothelial cells of a blood vessel (asterisk). (B) AML-M4 with myelo-monocytic and megakaryocytic involvement. (Top left) Myelo-monocytic cells in a marrow smear. (May-Grünwald-Giemsa, ×1000) The bone marrow biopsy from the same case shows an increased number of megakaryocytes (top right, arrow, hematoxylin and eosin, ×1000) displaying marked emperipolesis (bottom left, arrow hematoxylin and eosin, ×1000); T indicates a bone trabecula. (Bottom right) NPM (clone 376) is nuclear and cytoplasmic (red) in virtually all myelo-monocytic cells and megakaryocytes (arrow). (C) Bone marrow biopsy from AML-M4 with multilineage involvement, showing heterogeneous morphologic features in different areas. (Top left, hematoxylin and eosin ×400) Increased number of dysplastic megakaryocytes (arrows). (Top, right, hematoxylin and eosin, ×1000) Area with mixture of myelo-monocytic cells and displastic megakaryocytes (arrow). (Bottom, left, hematoxylin and eosin, ×1000) Area with mixture of proerythroblasts (arrowhead) and dysplastic megakaryocytes (arrow). (Bottom right, APAAP; hematoxylin counterstain, × 1000) NPM expression (clone 376) is detected in the nucleus and cytoplasm (red) of proerythroblasts (arrowhead) and megakaryocytes (arrow). The same NPM staining pattern (not shown) is also seen in myelomonocytic leukemic cells in other areas of the biopsy. The inset shows double immunostaining for surface glycophorin A (brown) and NPM (blue) in proerythroblasts from the same biopsy (immunoperoxidase/fast blue APAAP, no counterstain, ×1000). (Right panels). The ratios and type of lineages involved in each case (A-C) are schematically illustrated by the 4-axis diagram. Myel indicates myeloid; Mo, monocytic; Er, erythroid; Meg, megakaryocytic.

Each FAB category contains a mixture of leukemic cells of different lineages. (A) Hematoxylin and eosin (left) and NPM staining (right, APAAP; hematoxylin counterstain, ×1000) of an AML-M4, showing nuclear plus cytoplasmic NPM expression only in myeloid and monocytic cells. The arrow indicates the nucleus-restricted positivity in endothelial cells of a blood vessel (asterisk). (B) AML-M4 with myelo-monocytic and megakaryocytic involvement. (Top left) Myelo-monocytic cells in a marrow smear. (May-Grünwald-Giemsa, ×1000) The bone marrow biopsy from the same case shows an increased number of megakaryocytes (top right, arrow, hematoxylin and eosin, ×1000) displaying marked emperipolesis (bottom left, arrow hematoxylin and eosin, ×1000); T indicates a bone trabecula. (Bottom right) NPM (clone 376) is nuclear and cytoplasmic (red) in virtually all myelo-monocytic cells and megakaryocytes (arrow). (C) Bone marrow biopsy from AML-M4 with multilineage involvement, showing heterogeneous morphologic features in different areas. (Top left, hematoxylin and eosin ×400) Increased number of dysplastic megakaryocytes (arrows). (Top, right, hematoxylin and eosin, ×1000) Area with mixture of myelo-monocytic cells and displastic megakaryocytes (arrow). (Bottom, left, hematoxylin and eosin, ×1000) Area with mixture of proerythroblasts (arrowhead) and dysplastic megakaryocytes (arrow). (Bottom right, APAAP; hematoxylin counterstain, × 1000) NPM expression (clone 376) is detected in the nucleus and cytoplasm (red) of proerythroblasts (arrowhead) and megakaryocytes (arrow). The same NPM staining pattern (not shown) is also seen in myelomonocytic leukemic cells in other areas of the biopsy. The inset shows double immunostaining for surface glycophorin A (brown) and NPM (blue) in proerythroblasts from the same biopsy (immunoperoxidase/fast blue APAAP, no counterstain, ×1000). (Right panels). The ratios and type of lineages involved in each case (A-C) are schematically illustrated by the 4-axis diagram. Myel indicates myeloid; Mo, monocytic; Er, erythroid; Meg, megakaryocytic.

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