Figure 1-Blood in CML-AP
Peripheral blood smear on the left side showing circulating basophils and unremarkable neutrophils. Platelets are variable in size in the background. The smear on the right side demonstrates 2 basophils on the top with unremarkable neutrophils on the bottom. Occasional teardrop cells is noted but red cells are otherwise morphologically unremarkable. There was no evidence of circulating left shifted myeloid cells or blasts at this time. However, the smear was performed after pheresis and hence platelet counts appear normal on smear
Figure 2: Images of bone marrow core biopsy in CML–accelerated phase
Low power image demonstrating markedly hypercellular marrow with significantly increased numbers of megakaryocytes visualized at higher power. The image at the bottom depicts numerous megakaryocytes that comprise an admixture of dwarf forms with hypolobated nuclei (typical in CML) as well as forms comprising micromegakaryocytes with dysplastic features. The background comprised and equal admixture of maturing myeloid and erythroid precursors without the typical myelocyte bulge seen in chronic myeloid leukemia, chronic phase.
Figure 3: CD34 immunostain in CML–accelerated phase
Multiple images demonstrating several areas with increased numbers of CD34 positive blastic cells. The cells reached up to 10% in some areas. Occasional megakaryocytes demonstrate weak abnormal staining for CD34 noted on the image in the right.
Figure 4-Reticulin
The image shows very mild and focal fibrosis.
