Formalin-fixed, paraffin-embedded bone marrow sections of PMF, AML with
reticulin myelofibrosis, multiple myeloma, chronic lymphocytic leukemia, and idiopathic thrombocytopenic purpura with DAPI staining were exposed to 405-, 488-, 561-, and 633-nm channels in CLSM.
Frames D to F show
reticulin stain for reticular fibers; magnification, x40 (the arrow indicates a reticular fiber).
in 2010.[2] In the beginning, TAFRO stood for Thrombocytopenia (T), Anasarca (A), Fever (F),
Reticulin fibrosis (R), and Organomegaly (O) which was consistent with the clinical presentation of our patient.[4] In 2012, a diagnostic criterion was proposed for TAFRO syndrome at the Fukushima and Nagoya meeting, and some slight changes were made for the acronyms: F presented myelofibrosis and R for renal dysfunction.[4] This criterion was composed of 11 items [Table 1] which included both clinical and laboratory parameters.
Caption: Figure 4: (
Reticulin, 200x) hepatic plate thinning and compression adjacent to an area of nodularity.
Caption: Figure 2: A small, round, blue cell, neuroectodermal tumor ((a), HE) showing a nodular architecture and a dense
reticulin fiber network ((b), Gomori).
The bone marrow biopsy showed hypercellular marrow with striking granulocytic and megakaryocytic hyperplasia with atypical megakaryocytes and moderate
reticulin fibrosis (Figure 1(a)-1(c)).
The Masson trichrome stain confirmed dense well-established fibrosis in the bridging septa, and the
reticulin stain confirmed twinning of the cell plates.
There is no nuclear reactivity for p53 protein by immunohistochemistry, and no increase in
reticulin deposition is noted with the
reticulin stain.
Focal and Diffuse fibrosis was seen in 20 (87%) cases, ranging from grade I to III by
reticulin staining and unremarkable in 3 (13%) cases.
September 2016: Bone marrow biopsy comments: Chronic lymphocytic leukemia (10% involvement); JAK2 mutation positive, marked
reticulin fibrosis, consistent with myeloproliferative neoplasm, such as primary myelofibrosis.
On the same occasion, liver tissue samples were also taken, fixed with 10% formaldehyde, stained using hematoxylin and eosin (HE), periodic acid-Schiff and
reticulin stain protocols and analyzed with light microscopy.
