Acute non lymphoid-leukemia with unusual staining of blasts.

A 54-year-old man was admitted because of fatigue, headache, dyspnea and fever. At physical examination pallor, cutaneous purpura on both legs, hepatomegaly and splenomegaly were found. A blood count showed anemia (Hb 9.4 g/dL), thrombocytopenia (P 23u10/L) and leukopenia (WBC 2u10/L) with 18% neutrophils, 8% eosinophils, 55% lymphocytes, 2% monocytes, 3% eosinophilic metamyelocytes, 2% eosinophilic myelocytes and 9% blasts. Bone marrow was hypercellular with a monomorphic picture; there were 70% blasts. Morphology At low magnification blast cells showed an unusual greyish staining of the cytoplasm; at higher magnification they presented eccentric nucleolated nuclei, low N-C ratio, abundant cytoplasm containing granular grey material, located inside and around the Golgi area and often superimposed on the nucleus (Figure 1). In some blasts large vacuolar structures, sometimes including granules, were present (Figure 2, 3). A few cells were maturing and showed evidence of eosinophilic differentiation with anomalous staining of granules. Megakaryocytes and erythroid cells did not show dysplastic features.