images in haematology
Green-grey crystals in acute myeloid leukaemia
A 78-year-old man presented with progressive dyspnea, generalized weakness and weight loss. One year earlier he had been diagnosed with myelodysplastic syndrome, refractory anaemia with excess blasts type 1, and treated with azacitidine. Laboratory tests showed pancytopenia with a haemoglobin concentration of 91 g/l, white cell count of 10 9 109/l, neutrophil count of 03 9 109/l and platelet count of 111 9 109/l. A bone marrow aspirate contained 40% myeloblasts with Auer rods, 15% abnormal promyelocytes and 25% immature monocytes, compatible with acute myelomonocytic leukaemia. One striking finding was the presence of macrophages packed with a large number of oblong, green-grey crystals, ranging from 8 to 20 lm (image). Various forms of crystals were seen, including “cigar” and “needle” shapes. Free crystals were also noted scattered throughout the field. Cytogenetic analysis of the bone marrow showed no evidence of chromosomal abnormalities. The patient elected to pursue palliative care. The presence of green-grey crystals inside bone marrow macrophages is a form of acquired lipidosis of the bone marrow, a group of disorders in which lipid inclusions accumulate within histiocytes in the bone marrow. Other forms include pseudo-Gaucher cells, birefringent blue
First published online 27 November 2014 doi: 10.1111/bjh.13244
crystals and sea-blue histiocytes. Green-grey crystals consist of crystallized compound lipids generated from the breakdown of granulocyte membranes. It seems likely that the size and rigidity of these crystals cause fragmentation of the cell during film preparation so that free crystals may also be observed. Light green crystals are seen in less than 1% of patients with acute myeloid leukaemia. This morphological finding strongly supports a non-lymphoid origin of an acute leukaemia. They should not be confused with Charcot‒Leyden crystals composed of eosinophil lysophospholipase. Unlike green-grey crystals, Charcot‒Leyden crystals are bipyramidal and birefringent under polarized light microscopy. Charcot‒Leyden crystals occur in haematological malignancies or inflammatory conditions associated with eosinophilia. Amit Sud1, Ricardo Morilla2, Mark Ethell1, David Taussig1,2 and Konstantinos Liapis1,2 1
Haemato-Oncology Unit, The Royal Marsden Hospital, The Royal
Marsden NHS Foundation Trust, and 2Immunophenotyping Laboratory, Centre for Molecular Pathology, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Surrey, London, UK E-mail: [email protected]
ª 2014 John Wiley & Sons Ltd British Journal of Haematology, 2015, 168, 618
Green-grey crystals in acute myeloid leukaemia
A 78-year-old man presented with progressive dyspnea, generalized weakness and weight loss. One year earlier he had been diagnosed with myelodysplastic syndrome, refractory anaemia with excess blasts type 1, and treated with azacitidine. Laboratory tests showed pancytopenia with a haemoglobin concentration of 91 g/l, white cell count of 10 9 109/l, neutrophil count of 03 9 109/l and platelet count of 111 9 109/l. A bone marrow aspirate contained 40% myeloblasts with Auer rods, 15% abnormal promyelocytes and 25% immature monocytes, compatible with acute myelomonocytic leukaemia. One striking finding was the presence of macrophages packed with a large number of oblong, green-grey crystals, ranging from 8 to 20 lm (image). Various forms of crystals were seen, including “cigar” and “needle” shapes. Free crystals were also noted scattered throughout the field. Cytogenetic analysis of the bone marrow showed no evidence of chromosomal abnormalities. The patient elected to pursue palliative care. The presence of green-grey crystals inside bone marrow macrophages is a form of acquired lipidosis of the bone marrow, a group of disorders in which lipid inclusions accumulate within histiocytes in the bone marrow. Other forms include pseudo-Gaucher cells, birefringent blue
First published online 27 November 2014 doi: 10.1111/bjh.13244
crystals and sea-blue histiocytes. Green-grey crystals consist of crystallized compound lipids generated from the breakdown of granulocyte membranes. It seems likely that the size and rigidity of these crystals cause fragmentation of the cell during film preparation so that free crystals may also be observed. Light green crystals are seen in less than 1% of patients with acute myeloid leukaemia. This morphological finding strongly supports a non-lymphoid origin of an acute leukaemia. They should not be confused with Charcot‒Leyden crystals composed of eosinophil lysophospholipase. Unlike green-grey crystals, Charcot‒Leyden crystals are bipyramidal and birefringent under polarized light microscopy. Charcot‒Leyden crystals occur in haematological malignancies or inflammatory conditions associated with eosinophilia. Amit Sud1, Ricardo Morilla2, Mark Ethell1, David Taussig1,2 and Konstantinos Liapis1,2 1
Haemato-Oncology Unit, The Royal Marsden Hospital, The Royal
Marsden NHS Foundation Trust, and 2Immunophenotyping Laboratory, Centre for Molecular Pathology, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Surrey, London, UK E-mail: [email protected]
ª 2014 John Wiley & Sons Ltd British Journal of Haematology, 2015, 168, 618
