case_images: PMC10761215_01
case_images: Wright-Giemsa stained peripheral blood smear showing medium to large blasts with characteristic bilobed nucleus and variable cytoplasmic granularity. Several hypogranular forms intermixed with rare blasts showing prominent bright pink cytoplasmic granules and scant Auer rods.
case_images: CRIHEM2023-7979261.001.jpg
case_images: PMC10761215_01_CRIHEM2023-7979261.001.jpg
case_images: fig1
case_images: Auer rods (Figure 1). A population of abnormal cells comprising 35.68% of the total events was identified in the blast gate in a 10-color flow cytometric evaluation.
case_images: Blast population (aqua) gated based on (a) forward scatter and side scatter with (b) dimmer CD45 in a 10-color flow cytometric evaluation. Pertinent scatter plots show gated blasts are (c) positive for CD34 and CD117 (dim to negative), (d) positive for CD13 and CD33, (e) negative for CD22 and cMPO (cytoplasmic myeloperoxidase), (f) positive for CD64 and negative for CD14, (g) dim to negative for CD2 and negative for CD1a, and (h) partially positive (subset) for HLA-DR and negative for CD11c.
case_images: CRIHEM2023-7979261.002.jpg
case_images: PMC10761215_01_CRIHEM2023-7979261.002.jpg
case_images: fig2
case_images: The immunophenotype of the blasts is summarized in Table 1 and select dot plots are shown in Figures 2(a)-2(h).
case_images: The residual normal granulocytes, from the patient sample, gated on side scatter CD45 plot (a) show moderate cMPO (myeloperoxidase). (b) The cMPO expression from a healthy control (c) is much brighter and is shown for comparison.
case_images: CRIHEM2023-7979261.003.jpg
case_images: PMC10761215_01_CRIHEM2023-7979261.003.jpg
case_images: fig3
case_images: The blasts were negative for cMPO while residual normal granulocytes showed moderate cMPO as shown in Figures 3(a)-3(c).
case_images: Fluorescence in situ hybridization analysis with the PML/RARA (15q24/17q21) dual color, dual fusion translocation DNA probe showing an abnormal hybridization signal pattern, that showed a fusion of the PML and RARA loci in interphase nuclei in a background of normal cells negative for the fusion.
case_images: CRIHEM2023-7979261.004.jpg
case_images: PMC10761215_01_CRIHEM2023-7979261.004.jpg
case_images: fig4
case_images: Fluorescence in situ hybridization analysis with the PML/RARA (15q24/17q21) dual color, dual fusion translocation DNA probe revealed an abnormal hybridization signal pattern, which showed a fusion of the PML and RARA loci in 95 of 100 (95%) interphase nuclei consistent with fusion of the PML/RARA due to the t(15;17)(q24.1; q21.2) anomaly, corroborating the diagnosis (Figure 4).