#00066177

Clinical case in our Oncohematology hospital.

Male patient, 72 years old. Admitted to the service due to bicitopenia (Anemia and Plaquetopenia) with the presence of circulating blasts in the peripheral blood.

The initial analysis of peripheral blood revealed the presence of 80% of blasts.

The immature cells were of intermediate size, with cytoplasmic hypogranulation, loose chromatin and very evident nucleolus.

Now with the presence of nuclei in alters or butterfly wing.

Fibrinogen of 100 mg/dL.

The bone marrow examination was performed with immunophenotyping compatible with acute myeloid leukemia, suggestive of a hypogranular Promyelocytic M3 leukemia.

Immunophenotyping detected the presence of 88.7% of myeloid blasts (CD34-/CD13+/CD33+/CD117+/MPO+/CD15-/HLADR-) compatible with Acute Myeloid Leukemia.

With absence of CD34, CD15 and HLA-DR.

Myelogram: Marrow infiltrated by blasts, now discreet presence of Promielocytes (Faggot Cell) and Hypogranular Promyelocytes with butterfly wing appearance (Nucleo in alter).

Karyotype: translocation between the long arms of chromosomes 15 and 17

Rare PLM: Positive.

Important: Based on bone marrow aspirate and peripheral blood, it is the hematologist's responsibility to identify and recognize the hematological lineage for chemotherapy planning and in this case immediate initiation of ATRA.

In the case, the presence of promielocytes with cytoplasmic inclusions of Faggot cell was observed, being rare in the hypogranular variant LPA but already described in the literature.

Hematological dye used: Rosenfeld.

Department of Oncohematology
Muriaé Cancer Hospital.
Cristiano Varella Foundation. Brazil.