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4-6) Acute megakaryoblastic leukemia may present as panmyelosis with myelofibrosis, usually considered in the differential diagnosis of either entity.
We report an unusual case of atypical presentation of CML with trisomy 19 presenting as panmyelosis with myelofibrosis, with predominance of atypical megakaryocytes, in a 61-year-old, previously healthy woman.
The marrow findings, in conjunction with clinical findings, raised a few differential diagnostic possibilities: primary myelofibrosis, acute megakaryoblastic leukemia, or acute panmyelosis with myelofibrosis.
In addition, when there is leukoerythroblastosis in the peripheral blood along with increased fibrosis and increased atypical megakaryocytes and megakaryoblasts, then the differential diagnosis includes acute megakaryoblastic leukemia, acute panmyelosis with myelofibrosis, and transformed primary myelofibrosis.
Polycythemia vera usually presents with panmyelosis.
AML with recurrent cytogenetic translocations AML with t(8;21)(q22;q22) Acute PML with t(15;17)(q22;q21) Variant acute PML with t(v;17) AML with abnormal bone marrow eosinophils inv(16)(p13;q22) or t(16;16)(p13;q22) AML with 11q23 abnormalities AML with multilineage dysplasia With prior myelodysplastic syndrome Without prior myelodysplastic syndrome AML and myelodysplastic syndrome, therapy related Alkylating agent related Topoisomerase II inhibitor related Other types AML not otherwise categorized AML minimally differentiated AML without maturation AML with maturation Acute myelomonocytic leukemia Acute monocytic leukemia Acute erythroid leukemia Acute megakaryocytic leukemia Acute basophilic leukemia Acute panmyelosis with myelofibrosis Table 13.
Acute myeloid leukemia without maturation, acute myeloid leukemia with maturation, and the blasts of acute panmyelosis with myelofibrosis show nonspecific features, with frequent expression of markers associated with myeloid immaturity, such as CD34 and CD117, combined with variable expression of more general markers of myeloid lineage, including CD13, CD15, CD33, and CD64.
World Health Organization (2008) Categories of Acute Leukemiaa Acute myeloid leukemia AML with recurrent cytogenetic abnormalities (see Figure 1) AML with myelodysplasia-related changes Therapy-related myeloid neoplasms AML NOS Morphologic and immunophenotypic subtypes Acute panmyelosis with myelofibrosis Myeloid sarcoma Myeloid leukemia associated with Down syndrome Blastic plasmacytoid dendritic cell neoplasm Acute leukemia of ambiguous lineage Acute undifferentiated leukemia Mixed phenotype acute leukemia with t(9;22)(q34;q11.