Plasma cell leukemia, primary. In difficult cases flow cytometric immunophenotyping could be performed that usually shows a large population of either CD45 negative or CD45 dim cells (in the blast gate) that are dim or negative for CD20 and negative for CD19 that are also negative for CD5 or CD23. Cells are positive for CD38 and more specifically CD138. CD56 may be expressed by neoplastic plasma cells.
[ACUTE MONOCYTIC LEUKEMIA (AML-M5b)]. Another case showing promonocytes with nuclear folds and creases. Nuclear folds and indentations may also be seen in cases of microgranular acute promyelocytic leukemia (APL-M3v) but Auer rods can easily be identified in most cases of APL-M3v. Flow cytometric analysis of acute monocytic leukemia shows almost consistent expression of HLA-DR and CD33 and often that of CD117 and CD13. However, CD34 is generally negative M5b and more often positive in M5a…
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[AML-M6]. 3 large neoplastic proerythroblasts on the top and other maturer erythroid precursors below are shown. Note the typical salami-like nuclear chromatin in proerythroblasts and single prominent nucleoli. The nucleolus can be stretched or comma-shaped. A dysplastic erythroid precursor is also shown (arrowhead).
APL with in FAB, APML. kidney bean or bilobed nuclei with cytoplasm chock full of granules and Auer rods, to the microgranular variant, both still have strong MPO reaction. The Auer rods here are unique ultrastructurally!
Cloud Art or Nature's Cloud Symphonies: this multi-coloured cloud phenomenon is called Sundog: rainbow cloud when ice crystals appear in clouds & refract sun's rays. Photographer Robert Arn, here in Heyworth, Illinois, US