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Tracy I George - Atlas of Bone Marrow Pathology

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Tracy I George Atlas of Bone Marrow Pathology

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This text illustrates bone marrow aspirate, imprint and biopsy specimens showing characteristic features of a wide variety of neoplastic and non-neoplastic conditions. While the focus is on Wright-stained smears and hematoxylin-eosin stained biopsies, other key histochemical and immunohistochemical stains are illustrated that are vital for proper diagnosis. After a brief review of the normal bone marrow, reactive changes in the marrow are illustrated, including the bone marrow response in constitutional disorders and to metabolic changes throughout the body. This is followed by specific infectious disorders in the marrow and other non-neoplastic disorders. The remainder of the Atlas illustrates the various neoplasms that involve the bone marrow, including leukemias, lymphomas and non-hematopoietic neoplasms. The hematologic neoplasms are classified using the 2016 World Health Organization (WHO) classification. This overview of bone marrow disorders illustrates a wide variety of diseases that practicing pathologists and hematologists will encounter in their routine practice.DOWNLOAD FROM FREE FILE STORAGE

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Springer Science+Business Media, LLC 2018
Tracy I. George and Daniel A. Arber (eds.) Atlas of Bone Marrow Pathology Atlas of Anatomic Pathology
1. Normal Bone Marrow
Heesun J. Rogers 1
(1)
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
Heesun J. Rogers
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Keywords
Cellularity Erythroid cell Granulocyte Hematopoietic cell Megakaryocyte Normal bone marrow Stromal cell
The bone marrow examination is an important diagnostic procedure used for a wide variety of clinical conditions such as the diagnosis of myeloid or lymphoid neoplasms, various reactive conditions or metastatic, non-hematopoietic malignancies. Bone marrow examination is also used for confirmation or monitoring of a remission state, residual or recurrent disease state, or regeneration of bone marrow after various therapies. Bone marrow aspiration and biopsy of adequate quality are considered to represent overall bone marrow function.
A basic understanding of bone marrow structures and the correct identification of cells comprising normal bone marrow are very important in the interpretation of bone marrow pathology. The bone marrow is a well-organized structure confined in cortical bone and traversed by medullary or trabecular bone. The bone marrow has three components: hematopoietic cells, stroma/microenvironment, and medullary bone. Hematopoietic cells are embedded in a connective tissue stroma in intertrabecular spaces of medullary bone. The bone marrow is almost entirely occupied by hematopoietic cells, with the highest cellularity at birth or early infancy. The hematopoietic cells gradually decrease in the bone marrow with aging, and the bone marrow is replaced by adipose cells (fat cells). Hematopoietic cells derived from multipotent stem cells can be further differentiated into several lineage cells: erythrocytes, granulocytes, monocytes, megakaryocytes , and lymphocytes.
Tables list the characteristic cytologic features of erythroid cells, granulocytic cells, and megakaryocytic cells. These tables illustrate the various stages of maturation from the earliest recognizable immature cells to mature cells in the bone marrow. Erythroid precursor cells (normoblast or erythroblast) develop adjacent to macrophages and are subdivided into pronormoblasts, basophilic normoblasts, polychromatophilic normoblasts, and orthochromic normoblasts. Immature granulocytic cells develop adjacent to trabecular surfaces or arterioles and are further subdivided into blasts, promyelocytes, myelocytes, metamyelocytes, band neutrophils, and segmented neutrophils. Megakaryocytes, the largest hematopoietic cells in bone marrow, can be easily identified adjacent to sinusoids, but megakaryoblasts or immature megakaryocytes are often difficult to recognize in the bone marrow and can be readily identified in conjunction with immunohistochemistry or immunophenotype.
Table 1.1
Maturation of erythroid cells in bone marrow
Cell type
Characteristic morphology
Description
Pronormoblast (proerythroblast)
The most immature and largest cells in erythroid lineage 1224 m relatively - photo 1
The most immature and largest cells in erythroid lineage (1224 m), relatively high nuclear to cytoplasmic (N/C) ratio (78:1), round to slightly oval nucleus, finely reticulated chromatin, prominent nucleoli ( 1), and agranular basophilic cytoplasm
Basophilic normoblast
Smaller cells 1017 m than pronormoblast round nucleus high NC ratio 61 - photo 2
Smaller cells (1017 m) than pronormoblast, round nucleus, high N/C ratio (6:1), open to slightly condensed chromatin, distinct parachromatin, rarely visible or absent nucleoli in later stage, and deep basophilic cytoplasm
Polychromatophilic normoblast
Smaller cells 1015 m and lower NC ratio 41 than basophilic normoblasts - photo 3
Smaller cells (1015 m) and lower N/C ratio (4:1) than basophilic normoblasts, round nucleus with condensed chromatin, often cartwheel appearance, visible perinuclear halo, no nucleoli, and blue-gray to pink-gray cytoplasm
Orthochromic normoblast
More mature and smaller cells 812 m than polychromatophilic normoblast - photo 4
More mature and smaller cells (812 m) than polychromatophilic normoblast, abundant cytoplasm (N/C ratio 1:2) with pink-orange and minimally basophilic color similar to erythrocytes, round nucleus, and densely condensed or pyknotic chromatin
Erythrocyte
The most mature cells 785 m pink-orange to salmon color and no nucleus - photo 5
The most mature cells (78.5 m), pink-orange to salmon color, and no nucleus
Table 1.2
Maturation of granulocytic cells in the bone marrow
Cell type
Characteristic morphology
Description
Myeloblast
The most immature granulocytic cells 1520 m with high NC ratio 471 - photo 6
The most immature granulocytic cells (1520 m), with high N/C ratio (47:1), round to oval nucleus, fine to reticular chromatin with distinct nucleoli (15), and moderately basophilic cytoplasm with absent or minimal azurophilic granules
Promyelocyte
Slightly larger cells 1424 m than myeloblasts with high NC ratio 351 - photo 7
Slightly larger cells (1424 m) than myeloblasts, with high N/C ratio (35:1), eccentric round to oval nucleus, slightly coarse or finely reticular chromatin, distinct nucleoli (13), basophilic cytoplasm with paranuclear hof and prominent azurophilic (primary) granules, which may overlie the nucleus
Myelocyte
Slightly smaller cells 1018 m than blasts with more abundant cytoplasm NC - photo 8
Slightly smaller cells (1018 m) than blasts, with more abundant cytoplasm (N/C ratio 12:1), eccentric round to oval nucleus, more condensed chromatin, no nucleoli, bluish to pink cytoplasm with paranuclear hof, abundant lilac (secondary) granules, and scattered few azurophilic (primary) granules
Metamyelocyte
Size similar to or slightly smaller 1018 m than myelocytes with abundant - photo 9
Size similar to or slightly smaller (1018 m) than myelocytes, with abundant cytoplasm (N/C ratio 11.5:1), indented or kidney-shaped nucleus (indentation less than half the width of the nuclear margin), condensed chromatin, no nucleoli, pinkish cytoplasm with many secondary granules and rare primary granules
Band neutrophil
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