Hematologic slides

• Normocytic
• Normochromic
• Hyper segmented
• Hypochromic
• Macrocytic
• Poikelocytosis
• Anisocytosis
• Reticolocytoses
• Target cell
• Spherocytic
• sickle cell
A normal mature lymphocyte is seen on the left compared to a segmented PMN on the right. An
RBC is seen to be about 2/3 the size of a normal lymphocyte.
hypochromic anemia
Microcytic- hypochromic Anemia
Pernicious Anemia
Reticulocyte
Spherocytosis and Reticulocyte
Hereditary spherocytes
Nucleated RBC with Basophilic Stippling
lead
Fragmented RBC's are known as "schistocytes “
Tear drop cells
Rouleaux formation
sickle cells
sickle cell anemia
poikilocytosis
target" cells-
Malaria (Plasmodium vivax)
thanks
Lymphoblastic leukemia/lymphoma. Lymphoblasts have
fewer nucleoli than do myeloblasts, and the nuclear
chromatin is more condensed. Cytoplasmic granules are
absent.
The WBC's seen here are lymphocytes, but they are blasts--very immature cells with larger
nuclei that contain nucleoli. Such lymphocytes are indicative of acute lymphocytic leukemia
(ALL). ALL is more common in children than adults. Many cases of ALL in children respond well
to treatment, and many are curable
These mature lymphocytes are increased markedly in
number. They are indicative of chronic lymphocytic leukemia, a
disease most often seen in older adults. This disease responds
poorly to treatment, but it is indolent.
Acute myeloblastic leukemia. Myeloblasts have delicate
nuclear chromatin, prominent nucleoli, and fine azurophilic
granules in the cytoplasm
Acute promyelocytic leukemia. Bone marrow aspirate shows
neoplastic promyelocytes with abnormally coarse and numerous
azurophilic granules. Other characteristic findings include the
presence of several cells with bilobed nuclei and a cell in the center
of the field that contains multiple needle-like Auer rods.
Nucleated RBC and Howell-Jolly bodies,
• Here are very large, immature myeloblasts with many nucleoli. A
distincitve feature of these blasts is a linear red "Auer rod" composed
of crystallized granules. These findings are typical for acute
myelogenous leukemia (AML) that is most prevalent in young adults.
Chronic myelogenous leukemia. Peripheral blood smear
shows many mature neutrophils, some metamyelocytes, and
a myelocyte
• There are numerous granulocytic forms seen here, including immature myeloid
cells and bands. This condition is one of the myeloproliferative states and is known
as chronic myelogenous leukemia (CML) that is most prevalent in middle-aged
adults. A useful test to help distinguish this disease is the leukocyte alkaline
phosphatase (LAP) score, which should be low with CML and high with a leukemoid
reaction.
• Sometimes infections and inflammatory conditions can produce a marked
leukocytosis with left shift and immature myeloid forms in the peripheral blood,
resembling a leukemia. This is known as a leukemoid reaction, and it must be
distinguished from chronic myelogenous leukemia. Seen here are band neutrophils,
metamyelocytes, and myelocytes in a leukemoid reaction.
• One way to distinguish a leukemoid reaction from chronic myelogenous leukemia
(CML) is with the leukocyte alkaline phosphatase (LAP) stain. Seen here are
neutrophils with red cytoplasmic staining for LAP. Counting myeloid cells staining
with LAP yields a score. A high LAP score is seen with a leukemoid reaction, while a
low LAP score suggests CML.
Normal bone marrow is seen here at medium power, with
cellular marrow and adipose tissue. The large multinucleated
cells are megakaryocytes.
This is the appearance of normal bone marrow at high magnification. Note the presence of
megakaryocytes, erythroid islands, and granulocytic precursors. This marrow is taken from the
posterior iliac crest in a middle aged person, so it is about 50% cellular, with steatocytes
admixed with the marrow elements
Aplastic Anemia
• In contrast to aplastic anemia, leukemia results in a highly cellular marrow. The marrow
between the pink bone trabeculae seen here is nearly 100% cellular, and it consists of
leukemic cells of acute lymphocytic leukemia (ALL) that have virtually replaced or
suppressed normal hematopoiesis. Thus, though the marrow is quite cellular, there can be
peripheral cytopenias. This explains the complications of infection (lack of normal
leukocytes), hemorrhage (lack of platelets), and anemia (lack of red blood cells) that often
appear with leukemia.
• At high power, the bone marrow of a patient with acute
myelogenous leukemia is seen here. There is one lone
megakaryocyte at the right center.
Normal lymph node is seen here at low power. There is a thin connective tissue capsule, below
which is a subcapsular sinus into which the afferent lymphatics drain from the tissues. There are
follicles in the paracortical region beneath capsule. The pale germinal center of the follicle is
composed of B lymphocytes, macrophages, and follicular dendritic cells. There is a mantle zone
of T lymphocytes. The interfollicular regions are populated mainly by T lymphocytes, and
sinusoids with macrophages draining to the hilum from which the efferent lymphatic runs.
The paracortical region of a normal lymph node is shown here at
medium power. Beneath the capsule is a subcapsular sinus. There
is a follicle containing a germinal center. A mantle zone surrounds
the germinal center. An interfollicular region is present between
follicles.
• This is a more pronounced reactive change in a lymph
node, with a larger follicle and germinal center containing
macrophages. In general, lymph nodes in a benign reactive
process are more likely to enlarge quickly and be tender.
• At high magnification, the germinal center in this reactive
lymph node follicle has prominent macrophages with
irregular cellular debris (so-called "tingible body
macrophages"). Blood vessels are also more prominent.
• Findings that favor a diagnosis of follicular
hyperplasia are (1) preservation of the lymph node
architecture, with normal lymphoid tissue between
germinal centers; (2) marked variation in the shape
and size of the lymphoid nodules; (3) a mixed
population of lymphocytes at different stages of
differentiation; and (4) prominent phagocytic and
mitotic activity in germinal centers.
• Here is a lymph node involved by lymphoma, a malignant process characterized by the
proliferation of neoplastic lymphoid cells. The capsule of the node has been invaded and the
lymphomatous cells extend into the surrounding adipose tissue. Note that the follicles are
numerous and irregularly sized. This is a malignant lymphoma, small cleaved cell type,
follicular (also known as: malignant lymphoma, poorly differentiated lymphocytic type,
nodular).
• This pattern of malignant lymphoma is diffuse and no lymphoid follicles are
identified. Under low power, note that the normal architecture of the lymph node
is obliterated. The lymph node is replaced by an infiltrate of small (mature-
appearing) neoplastic lymphocytes, and the infiltrate extends through the capsule
of the lymph node and into the surrounding fat. The diagnosis is: malignant
lymphoma, small lymphocytic type, diffuse (also known as: "well-differentiated"
lymphocytic lymphoma).
• Many non-Hodgkin's lymphomas seen in adults are large cell lymphomas such as the one
here at medium power, but they can be associated with immunosuppressed states (such as
AIDS), and are most often of B cell origin. The cells are large, with prominent nucleoli and
abundant cytoplasm. This disease tends to be localized (low stage), but with more rapid
enlargement, and a greater propensity to be extranodal than the low grade lymphomas.
• Here is an enlarged 5 cm lymph node (obviously from a
patient with lymphadenopathy). The node should normally
be soft and pink and less than 1 cm in size. This lymph node
is involved with Hodgkin's disease. This gross appearance
could pass for a non-Hodgkin's lymphoma as well.
• Note the large cells with large, pale nuclei containing large purple
nucleoli at the arrowheads. These are Reed-Sternberg cells that are
indicative of Hodgkin's disease. Most of the cellular content of foci of
Hodgkin's disease consists of reactive lymphoid cells. There are four
main subtypes of Hodgkin's disease: lymphocyte predominance,
nodular sclerosis, mixed cellularity, and lymphocyte depletion.
• This is a high power view of a Reed-Sternberg cell
seen with Hodgkin's disease. Note the large,
prominent nucleoli.
Hodgkin lymphoma. A binucleate Reed-Sternberg cell with
large, inclusion-like nucleoli and abundant cytoplasm is
surrounded by lymphocytes, and an eosinophil can be seen
below.
• This is Hodgkin's disease, nodular sclerosis type. Note the
bands of pink collagenous tissue dividing the field in this
lymph node.
Hodgkin lymphoma, nodular sclerosis type. A low-power view
shows well-defined bands of pink, acellular collagen that have
subdivided the tumor cells into nodules.
• At high power, there are scattered large cells with a surrounding prominent clear
space, an artifact of formalin fixation. These are the lacunar cells characteristic for
the nodular sclerosis type of Hodgkin's disease.
Hodgkin lymphoma, nodular sclerosis type. A distinctive
"lacunar cell" with multilobed nucleus containing many
small nucleoli is seen lying within a clear space created by
retraction of its cytoplasm. It is surrounded by
lymphocytes.
• This is Hodgkin's disease, mixed cellularity type. A
mixed cell population is present. This form of HD
tends to be disseminated.
Hodgkin disease, mixed-cellularity type. A diagnostic,
binucleate Reed-Sternberg cell is surrounded by multiple cell
types, including eosinophils (bright-red cytoplasm),
lymphocytes, and histiocytes.
• This is Hodgkin's disease, lymphocyte predominance type.
Many lymphocytes compose this type of HD. A variant
Reed-Sternberg cell with a multilobulated nucleus is seen.
Hodgkin disease, lymphocyte-predominance type.
Numerous mature-looking lymphocytes surround scattered,
large, pale-staining lymphocytic and histiocytic variants
("popcorn" cells).
• This is Hodgkin's disease, lymphocyte depletion
type. Many Reed-Sternberg cells and variants are
present, as seen here at medium and high
magnification. This type of HD is not common.
• In this bone marrow biopsy section at medium power, there are sheets of plasma cells of
multiple myeloma that are very similar to normal plasma cells, but the cells may also be
poorly differentiated. Usually, the plasma cells are differentiated enough to retain the
function of immunoglobulin production. Thus, myelomas can be detected by an
immunoglobulin "spike" on protein electrophoresis as shown below, or the presence of
Bence-Jones proteins (light chains) in the urine. Immunoelectrophoresis characterizes the
type of monoclonal immunoglobulin being produced.
• Here is a smear of bone marrow aspirate from a patient with multiple
myeloma. Note that there are numerous well-differentiated plasma
cells with eccentric nuclei and a perinuclear halo of clearer
cytoplasm. There is also an abnormal plasma cell with a double
nucleus.
Bone marrow aspirate. Normal marrow cells are largely
replaced by plasma cells, including atypical forms with
multiple nuclei, prominent nucleoli, and cytoplasmic
droplets containing immunoglobulin.
• Seen here are neoplastic glandular configurations representing
metastatic adenocarcinoma. The nodes draining from the primary
site of a carcinoma are most commonly involved, but distal nodal
groups may be involved as well. Similar to lymphoma, metastases
produce firm, painless enlargement of the lymph nodes.
• This is the normal appearance of the spleen at low power with white pulp
(lymphocytes) surrounding a central arteriole. The red pulp forms the bulk of the
splenic parenchyma. The splenic capsule is seen at the left, and connective tissue is
also present within the spleen as trabeculae that carry the arteries, veins, and
nerves from the hilum.
Normal spleen at medium power demonstrates
white pulp (lymphocytes) surrounding a central
arteriole. The red pulp forms the bulk of the splenic
parenchyma.
• This section of spleen demonstrates numerous pale tan granulomas.
Both microbiologic cultures as well as special stains of the tissue for
organisms were negative. This middle-aged female also had
pulmonary non-caseating granulomas as well as hilar
lymphadenopathy. This is a case of sarcoidosis, a granulomatous
disease of unknown etiology.
• The large pale nodule and several smaller nodules seen
here in this section are the result of splenic involvement by
Hodgkin's disease.
• Despite its size, the spleen is a rare site for metastases from non-hematologic
malignancies. Seen here are metastases from a melanoma of the skin. Note that
most of these masses are tan, but some have brown-black pigmentation from
melanin elaborated by the neoplastic cells. Melanomas can be widely metastatic.
The normal thymus of a fetus and an infant seen here is well-populated with T lymphocytes. At
low power can be seen a well-defined cortex and medulla. There are a few Hassall's corpuscles
composed of epithelial cells.
• Normal adult thymus is seen at low magnification.
Beyond puberty, the thymus continues to atrophy, with
decreasing numbers of lymphocytes, so that the adipose
tissue becomes more prominent. Occasional Hassall's
corpuscles appear in the lymphoid areas.