Case 31 part 2 – summary

So… we have a leucoerythroblastic film (left shifted granulopoiesis and nucleated red cells) along with tear drop cells.

Case 32 part 1 annotated

The main differentials the team came up with were:

  • Myelofibrosis (primary or secondary – he did have a haematology past)
  • Metastatic carcinoma
  • Beta thalassaemia
  • Iron deficiency

As us haematologists are keen we saw him for a marrow biopsy. We found out that he indeed previously had polycythaemia vera with the JAK2 V617F mutation. The initial marrow was a dry tap as expected… but we did see these  cells after looking around for a while:

Carcinoma1 Carcinoma2

Here is part of the trephine:

Carcinoma4

The marrow infiltration was patchy and in other areas it was heavily fibrotic with no evidence of carcinoma. His ferritin was low and had iron deficiency.

Final diagnosis

  • Metastatic adenocarcinoma – colonic
  • Secondary (post polycythaemia) myelofibrosis
  • Iron deficiency

About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Haemoglobinopathy, Laboratory morphology, Myeloproliferative neoplasm, Related to other specialities and tagged , , , . Bookmark the permalink.

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