case_images: PMC5727626_01
case_images: Peripheral smear with mast cell.
case_images: CRIONM2017-9249302.001.jpg
case_images: PMC5727626_01_CRIONM2017-9249302.001.jpg
case_images: fig1
case_images: The peripheral blood smear showed 12% mast cells (Figure 1).
case_images: Hypercellular bone marrow with aggregates of mast cells.
case_images: CRIONM2017-9249302.002.jpg
case_images: PMC5727626_01_CRIONM2017-9249302.002.jpg
case_images: fig2
case_images: Her bone marrow biopsy showed 100% cellularity with aggregates of interstitial, perivascular, and paratrabecular mast cells in fibrotic stroma with spindling (Figure 2).
case_images: Bone marrow aspirate with degranulated mast cell.
case_images: CRIONM2017-9249302.003.jpg
case_images: PMC5727626_01_CRIONM2017-9249302.003.jpg
case_images: fig3
case_images: The mast cells showed degranulation with monolobated nuclei and some having blast-like chromatin (Figure 3).
case_images: Tryptase stain of bone marrow.
case_images: CRIONM2017-9249302.004.jpg
case_images: PMC5727626_01_CRIONM2017-9249302.004.jpg
case_images: fig4
case_images: A tryptase stain was diffusely taken up in the bone marrow (Figure 4).
case_images: Karyotype from the 2014 bone marrow aspirate after diagnosis of transformation to mast cell leukemia. The arrows point to the t(9;22) and arrowhead to the del(20q).
case_images: CRIONM2017-9249302.005.jpg
case_images: PMC5727626_01_CRIONM2017-9249302.005.jpg
case_images: fig5
case_images: However, 7 of the 17 cells also showed the characteristic t(9;22) (Figure 5).
case_images: Metaphase with FISH for ASS1 (spectrum aqua)/ABL1 (spectrum orange)/BCR (spectrum green). The arrows point to the 2 fusion signals on der(9) and der(22). The other fusion signal on normal chromosome 9 is the result of juxtaposition of ASS1 (spectrum aqua) with ABL1 (spectrum orange) and does not represent the typical fusion seen with BCR/ABL1.
case_images: CRIONM2017-9249302.006.jpg
case_images: PMC5727626_01_CRIONM2017-9249302.006.jpg
case_images: fig6
case_images: Interphase FISH analysis confirmed the presence of BCR/ABL1 fusion in 20% of the nuclei and also demonstrated a 20q deletion in 91.5% of the nuclei (Figure 6).