case_images: PMC10632061_01
case_images: Morphologic findings of the bone marrow aspirate. The infiltrate of medium-sized blastic cells with perinuclear microvacuoles ("pearl neckless"), eccentric nuclei, fine chromatin texture, and few nucleoli is demonstrated on the upper three panels (Wright Giemsa stain, x50 magnification). H&E and immunohistochemical staining findings are demonstrated in the lower 6 panels (x20 magnification).
case_images: CRIHEM2023-5014728.001.jpg
case_images: PMC10632061_01_CRIHEM2023-5014728.001.jpg
case_images: fig1
case_images: These blastic cells occasionally resembled "hand mirrors" (Figures 1(a)-1(c); upper panels). A hypocellular biopsy revealed a monomorphic cellular infiltrate with abundant eosinophilic cytoplasms (Figures 1(d)-1(i); lower panels).
case_images: Flow cytometry of the bone marrow aspirate. The neoplastic population is coloured in red and demonstrates positivity for dim CD45, CD4, CD56, CD117, CD123, and CD64.
case_images: CRIHEM2023-5014728.002.jpg
case_images: PMC10632061_01_CRIHEM2023-5014728.002.jpg
case_images: fig2
case_images: Tandem flow cytometry showed an atypical population of dim CD45 events with expression of CD4, CD56, CD117, CD123, and CD64 (Figures 2(a)-2(f); Crimson population).
case_images: Fluorescence in situ hybridization (FISH) showing the evidence of a KMT2A rearrangement (break-apart probes; normal KMT2A indicated by a yellow fusion signal. Red and green signals imply translocation/break-apart).
case_images: CRIHEM2023-5014728.003.jpg
case_images: PMC10632061_01_CRIHEM2023-5014728.003.jpg
case_images: fig3
case_images: The current study did not identify the exact partner gene (candidates include ELL at 19p13.1 or MLLT1 at 19p13.3; Figures 3 and 4, respectively).
case_images: Karyotype demonstrating a t(11; 19) translocation (derivative chromosomes indicated with arrows) as well as an isochromosome 6p.
case_images: CRIHEM2023-5014728.004.jpg
case_images: PMC10632061_01_CRIHEM2023-5014728.004.jpg
case_images: fig4
case_images: The current study did not identify the exact partner gene (candidates include ELL at 19p13.1 or MLLT1 at 19p13.3; Figures 3 and 4, respectively).