Marrow Collection Series

20 HIGH YIELD
PATHOLOGY SLIDES
FROM MARROW

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 Acute Myeloid Leukemia

Blasts maybe more than 100,000/mm3, but are

under 10,0000/mm3 in about 50% of patients.
Diagnosis is based on presence of atleast 20%
myeloblasts with delicate nuclear chromatin, two to
four nucleoli, and voluminous cytoplasm and CD33
positive.
Presence of fine azurophillic granules and Aeur rods.
 Faggot cells

Multiple auer rods clustered together within a single

cell resembling a bundle of sticks. These have been
termed as "Faggot cells".
 Acute Lymphocytic Leukemia

Usually seen in adolescent boys with thymic

involvement (50%- 70%).
Tdt/CD34/CD7 positive.
Lymphoblasts with condensed nuclear chromatin,
small nucleoli, and scant agranular cytoplasm.
 Chronic Lymphocytic Lymphoma

Increased lymphocytes with scant cytoplasm.

Round to irregular nuclei containing clumped
chromatin and many smudge cells/basket
cells/parachute cells.
Absolute lymphocyte count is >5000 per mm3.
 Chronic Myelogenous Leukemia

Leukocytosis with leukocyte count often exceeding

100,000 cells/mm3, which consists predominantly of
neutrophils, band forms, metamyelocytes, myelocytes,
eosinophils and basophils ( hypercellular bone marrow).
Blasts usually make up less than 5% of circulating
cells.
Increased platelet count.
 Myelodysplastic syndrome

Dysplastic cells.
Presence of Ringed sideroblasts - erythroblasts with
iron - laden mitochondria visible as perinuclear
granules (in Pearl's Prussian blue-stain.)
Pseudo-Pelger-Hüet cells, neutrophils with only two
nuclear lobes, are commonly observed.
Megakaryocytes with single nuclear lobes or multiple
separate nuclei (pawn ball megakaryocytes) are
also characteristic.
 Iron deficiency anemia

Microcytic.
Hypochromic blood picture (zone of central pallor is
enlarged )
Poikilocytosis in the form of small, elongated red cells -
- pencil cells.
Anisocytosis
 Megaloblastic anemia

Anisopoikilocytosis.
Macro - ovalocytes.
Most macrocytes lack the central pallor of normal red
cells and even appear “hyperchromic".
Hypersegmented neutrophils having five or more
nuclear lobules.
 Papillary carcinoma of thyroid

Branching papille and follicles with fibrovascular stalk,

Psammoma bodies .
Nuclear changes - Optically clear-ground glass or
Orphan Annie eye nuclei, pseudo-inclusions, nuclear
grooves.
Post -streptococcal glomerulonephritis

Enlarged hypercellular glomerluli with influx of

leucocytes (endocapillary proliferation).
Appears 1-4 weeks after a streptococcal infection of the
pharynx or skin.
The streptococcal antigenic component responsible is
Streptococcal pyrogenic exotoxin B.
 Pulmonary anthracosis

Microscopic imaging showing abundant black colour

pigment within the macrophages of hilar lymph node
characteristic of pulmonary anthracosis.
The inhaled carbon particles are engulfed by the lung
macrophages and then transported to the hilar lymph
node causing blackening of tissue.
It may induce fibroblastic reaction or emphysema that
may lead to Coal worker's pneumoconiosis.
 Asbestosis

Asbestosis is marked by diffuse pulmonary

interstitial fibrosis, with presence of asbestos
bodies.
Asbestos bodies are golden brown, fusiform or
beaded rods with translucent centre. They consisit
of asbestos fibres coated with iron-containing
proteinaceous material and arise when
macrophages phagocytose asbestos fibres.
 Schwannoma

Hypocellular (Antony B ) and hypercellular areas

(Antony A)
Antony A - nucleus of tumour cells aligned in
palisading rows.
Nuclear free zones in between nuclear palisading are
known as Verocay Bodies .
 Rheumatic valvular disease

Presence of Aschoff bodies - collection of

lymphocytes (primarily T cells), scattered plasma
cells, and plump activated macrophages called
Anitschkow cells associated with zones of fibrinoid
necrosis.
The Anitschkow cells have abundant cytoplasm and
nuclei with chromatin that is centrally condensed into
a slender, wavy ribbon - "caterpillar cells"
 Hemochromatosis

The hepatocellular cells appear as bluish granules

when stained with perl's prussian blue stain.
Hemochromatosis is an inherited or acquired metabolic
disorder caused by excessive iron accumulation.
The total body iron accumulation may exceed 50gm.
 Molluscum contagiosum

Large, ellipsoid, homogenous, cytoplasmic

inclusion in cells of the stratum granulosum and the
stratum corneum classically seen in molluscum.
Cuplike verrucous epidermal hyperplasia.
Tzanck smear : intracytoplasmic molluscum bodies
( Henderson - Patterson bodies), the largest
known inclusion bodies.
 Burkitts Lymphoma

Tumour cells with multiple small nucleoli, minimal

cytoplasm and high mitotic index closely apposed
to each other . (starry sly appearance)
The macrophages get stuffed in between along
with cellular debris which are called tingible body
macrophages.
Neoplastic cells are BCL2 negative.
 Bronchial asthma

The image shows Charcot -leyden crystals, lake of

mucus, and numerous eosinophils which are diagnostic
of bronchial asthma.
Microscopy of sputum shows:
1. Charcot-Leyden crystals : Made of an eosinophillic
membrane protein called galactic 10.
2. Curschmann spirals: Spirals of mucus plugs from
subepithelial mucous gland ducts or bronchioles.
3. Creola bodies : Individual epithelial cell clusters shed in
the sputum
 Ewings sarcoma

Sheets of small, uniform round cells with scant

cytoplasm, which apprears clear as it is rich in
glycogen.
Presence of Homer-Wright rosettes.
The characteristic periosteal reaction produces
layers of reactive bone deposited in an onion-skin
fashion.
 Giant cell tumour (GCT) of bone

The neoplastic cells express high levels of RANKL,

which promotes the proliferation of osteoclast
precursors and their differentiation into mature
osteoclasts via RANK expressed by these cells.
Sheets of uniform oval mononuclear cells and
numerous osteoclast-type giant cells with 100 or more
nuclei.