#00062093

A 28-year-old- male with pancytopenia was referred for a second opinion for the diagnosis of Aplastic Anemia. The patient had chronic GI symptoms of abdominal pain, poor appetite, nausea, and diarrhea alternating with constipation, all of which had worsened recently. Patient stated that he has lost 50 lb weight in the past year. Patient had a past history of alcohol abuse disorder, but has been in remission for 5 years and denied illicit drug use or tobacco. The GI work-up, including colonoscopy and CT enterography, was unremarkable except for a 4 X 4 cm left pelvic mass, proven to be schwannoma. Laboratory values: hemoglobin 10.2 g/dL; red blood cell count 3.18 M/uL; MCV 98.7 fL; white blood cell count 2.90 K/uL; platelet count 219 K/uL; transferrin 192 mg/dL; iron 70 μg/dL; ferritin 467 μg/L; alanine aminotransferase 46 U/L; aspartate aminotransferase 37 U/L; alkaline phosphatase 35 U/L, HIV negative. Bone marrow aspirate Cytogenetic analysis showed normal male karyotype and 50-gene myeloid Next Generation Sequencing panel was unremarkable.

Bone marrow biopsy evaluation on H&E stain showed paucicellular marrow with trilineage hematopoiesis and extensive deposition of extracellular gelatinous material, consistent with serous fat atrophy (gelatinous transformation) (Panel A).  Alcian blue stain at a pH of 2.5 highlighted gelatinous material rich in hyaluronic acid (Panel B). S100 stain highlighted atrophied adipocytes (Panel C). Congo red stain was negative (not shown). Reticulin stain showed no significant fibrosis (not shown). Aspirate smear evaluation revealed extensive poorly stained acellular material with background maturing trilineage hematopoiesis.