granules and a stippled
nuclear chromatin.
CMML-1 (BM)
CMML-2(BM)
Representative peripheral blood and BM smears distinction between promonocytes 精a品n课d件abnormal monocytes may be
monocytic proliferation can be difficult to appreciate (cytochemistry and immunohistochemistry)
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Abnormal monocytes have denser Monocytosis with morphologically chromatin, nuclear normal monocytes (PB) convolutions and folds and
grnulocytic proliferation an increase in erythroid precursors mild to moderate increase in the amount of reticulin fibres (30%)
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Immunohistochemistry on tissue sections
CMML诊治进展
江苏省人民医院 血液科 洪鸣
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Contents
1 Definition 2 Diagnosis 3 Risk stratification 4 Therapeutic options
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Definition
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WHO Classification of MDS/MPN
1 CMML
2 Atipical CML, BCR-ABL1 negative
3 JMML
4 MDS/MPN, U (RARS-T, refractory
anemia with ringed sideroblasts associated with thrombocytosis)
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Definition
a more grMoenoycyitseshwitchyntucolepalr aansdm. Cytoplasmic abnormalities (PB)
Promonocytes typically have
a light-gray cytoplasm with
a few lilac-colored
A clonal hematopoietic stem cell disorder that is characterized by the presence of an absolute monocytosis (>1×109/L) in the peripheral blood and the presence of myelodysplastic and myeloproliferative features in the bone marrow.
relatively insensitive as compared with cytochemistry or flow cytometry
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Morphology (BM)
hypercellular in over 75% of cases
normalcellular and hypocellular also occur
dysgranulopoiesis, dyderythropoiesis, micromegakaryocytes and megakaryocytes with abnormally lobated nuclei (in up to 80% of patients)
Immunophenotype
The PB and BM cells usually express CD33 and CD13, with variable expression of CD14, CD68, CD64.
An increased percentage of CD34+ cells has been associated with early transformation to acute leukemia.
(WHO classification of myeloid neoplasms)
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Diagnosis
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Clinical manifestation
• MDS-type
– Fatigue and dyspnea due to anemia – susceptibility to infections – rarely bleeding
The monocytes generally are mature, but can exhibit abnormal granulation or unusual nuclear lobation or chromatin patten. (abnormal monocytes)
Dysgranulopoiesis is present in most cases.
• MPபைடு நூலகம்-type
– significant weight loss – drenching nigh sweats – left upper quadrant pain from significant
splenomegaly
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Morphology (PB)
PB monocytes usually range from 2 to 5 × 109/L, but may exceed 80 × 109/L.
Occasionally, overexpression of CD56, aberrant expression of CD2, and decreased expression of HLA-DR, CD13, CD15, and CD36 may be observed.
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Histopathology