Contributed by Dragos C. Luca, M.D.
Age related normal values in bone marrow
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Fatty marrow
AFIP images
6 month old child has highly cellular marrow (normal for age)
Adult marrow (ages 30 - 69 years)
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Adult marrow
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Marked megaloblastic features
Markedly hypercellular
Bone marrow: intracytoplasmic vacuoless
Multiple coarses granules
Plasma cell: iron granules forming plaque
Hemosiderin granules in normoblast
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Peripheral blood erythrocytes
Vacuolation of peripheral blood cells
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Marrow plasma cell has dense aggregate of iron
Iron laden organelle
in upper cell may
correspond to
microscopic plaque
Contributed by Valentina Sangiorgio, M.D.
Hypocellular bone marrow
Absence of fibrosis
Virtual absence of myeloid cells
Isolated residual erythroid islands
Virtual absence of megakaryocytes
Normal CD34 count
Mast cell hyperplasia
Contributed by Valentina Sangiorgio, M.D.
PNH red cell tube
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Pigment changes and
palmoplantar hyperkeratoses
are characteristic of
chronic arsenic exposure
Arsenic keratosis -
so called "raindrops
on a dusty road"
Skin cancer
AFIP images
Bone marrow: erythroid
precursors have marked
dysplastic changes including
nuclear lobulation and karyorrhexis
AFIP images
Erythroid precursor with
slightly lobulated
megaloblastoid nucleus
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Abnormal erythroblasts
Contributed by Ria Vergara-Lluri, M.D.
Markedly hypercellular bone marrow
Erythroid hyperplasia
Megakaryocytic hyperplasia without atypia
Sinusoidal dilation
MF grade 1
MF grade 2
Benign lymphoid aggregate
Benign lymphoid aggregate immunostains
Polytypic plasmacytosis
Contributed by Ria Vergara-Lluri, M.D.
Peripheral blood smear
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Basophilic myelocyte
Basophilic metamyelocyte
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Basophil
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Basophil
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Schematics
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Blood clot
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Poor technique
Smear: good and poor technique
Epoxy resin embedded bone marrow biopsies
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FISH from tissue imprints
AFIP images
Promyelocytes and myelocytes in upper field
Foci of erythropoiesis
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Giant inclusion bodies
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Site unknown (not bone marrow)
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Extensive vacuolation of erythroid precursors
Vacuoles in erythroid precursors
Vacuoles in immature granulocytes
Vacuoles in myelocyte and basophilic normoblast
Cytoplasmic vacuoles in two pronormoblasts
Sideroblasts (Prussian blue)
Pelger-Huët nuclear anomaly
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Dimorphic RBCs
More pronounced
anisopoikilocytosis
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Hypothetic model for abortive
ribosome assembly and p53
activation relevant to DBA
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Defects in cellular proliferation
and differentiation that give rise
to dyskeratosis congenita
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Reticular skin pigmentation
Reticular pigmentation
Dorsum of tongue
Ulceroproliferative growth
Clinical data of the DKC proband in the first pedigree
Plantar surface of hands
Palmar surface of hands
Hyperpigmentation and dystrophic nails
Epiphora and ectropion
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Histopathological features of dyskeratosis congenita
Lymph node: metastatic squamous cell cac
Dorsum of tongue: squamous cell carcinoma
Dorsum of tongue:
richly vascular
with mild chronic
inflammatory infiltrate
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Blood islands in embryo
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Yolk sac at 18 days
Fetal liver at 17 weeks
Fetal bone marrow at 19 weeks
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Eosinophilic metamyelocyte
Developing eosinophils
AML-M4eo:
Various eosinophil precursors
Hypereosinophilic syndrome:
Bone marrow aspirate
Bone marrow biopsy
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Hypereosinophilic syndrome:
Peripheral blood
Peripheral blood:
Eosinophils
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Normal eosinophil with crystalloid granules
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Erythropoiesis
AFIP images
Erythroblast island
Proerythroblast is large cell at
upper left of center; there are
also basophilic, polychromatophilic
and orthochromatic normoblasts
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Orthochromatic normoblast
Proerythroblast
Polychromatophilic normoblast
Basophilic normoblast
Reticulocyte
Basophilic and polychromatophilic normoblasts
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Normal erythrocyte
Reticulocyte
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Diagnostic algorithm
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Clinodactyly with brachymesophalangia
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Hypocellular spicule with fatty infiltration
Aspirate smear findings
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Chromosome breakage test
Representative karyotypes
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Prominent gelatinous transformation
Serous atrophy
Various images
AFIP images
Hematopoietic cell differentiation
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Hematopoietic cell differentiation
Normal bone marrow differential in adults
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Bone marrow biopsy:
Normal marrow
Bone marrow aspirate smear:
Normal
Contributed by Natasha Savage, M.D. and Yulan Jin, M.D., Ph.D.
Nonnecrotizing granuloma
Necrotizing granuloma
GMS stain
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Normal hematogone maturation
Contributed by Giby V. George, M.B.B.S. and AFIP
Bone marrow aspirate hematogones
Bone marrow aspirate hematogones
Sparse, lightly basophilic cytoplasm
Increased hematogones evenly distributed
Clumped nuclear chromatin
Contributed by Giby V. George, M.B.B.S.
Hematogone maturation in the background of B ALL
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Normal hematogone maturation by flow cytometry
ICCS: B cells, features of immaturity
Ace My Path: B cell maturation
Contributed by Sherif A. Rezk, M.D. and AFIP
Bone marrow
hemophagocytosis
Reactive hemophagocytosis in lymph node
Erythrophagocytosis
Neutrophil
hemophagocytosis
Platelet
hemophagocytosis
Bone marrow in
reactive
hemophagocytic
syndrome
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Megaloblastic anemia
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Bone marrow fragment showing iron deposits
Iron
Normal iron stores
Increased iron stores
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Clumped and free ferritin
Erythroblast contain ferritin
Macrophage and erythroblast cytoplasm
Erythroblasts with ferritin
Clumped, vesticle and free ferritin
Erythroblast with a clump of ferritin
Iron in mitochondria
Erythroblast containing mitochondrial iron
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Normal lymphocytes
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Small lymphocyte
With cytoplasmic projections
Contributed by Barina Aqil, M.D.
Pattern 1
Pattern 2
Pattern 3
Pattern 4
Pattern 5
Pattern 1 (CD3)
Pattern 2 (CD3)
Pattern 3 (CD3)
Pattern 4 (CD3)
Pattern 5 (CD3)
Pattern 1 (CD20)
Pattern 2 (CD20)
Pattern 3 (CD20)
Pattern 4 (CD20)
Pattern 5 (CD20)
Contributed by Barina Aqil, M.D.
Sheet of small lymphocytes
Contributed by Ramya Gadde, M.D. and AFIP
Scattered mast cells
Spindle shaped mast cells
Tryptase
Scattered mast cells with basophilic granules
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Degranulating mast cell
Mast cells with abundant granules
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Megakaryopoiesis pathways
Proplatelet formation
Contributed by Dragos C. Luca, M.D. and AFIP images
Emperipolesis
Endomitosis
Megakaryocytes
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Megakaryoblasts
Megakaryocytes
Emperipolesis
CD62P+ megakaryocyte
Platelet formation
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Platelets
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Glossitis, smooth tongue
Contributed by Julie Teruya-Feldstein, M.D. and Swati Bhardwaj, M.B.B.S., M.D.
Erythroid hyperplasia
Megaloblasts and erythroid nuclear dysplasia
Erythroid hyperplasia and nuclear abnormalities
Frequent mitoses and neutrophil hypersegmentation
Hypersegmented neutrophil
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Macroovalocytosis /
round macrocytes
in liver disease
Macrocytosis with a lymphocyte
Megaloblastoid erythroids, basophils, mast cells in a bone marrow smear
AFIP images
Promonocyte
Bone marrow in acute monocytic leukemia (AML M4):
Monoblasts are larger cells with abundant
cytoplasm and round nuclei and
promonocytes are two cells with folded and
creased nuclei next to monoblast in center
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Monocyte
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Monocyte - TEM and SEM
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Necrotic and nonnecrotic areas
Disruption of normal bone marrow architecture
Antiphospholipid syndrome
Nuclear features associated with necrosis
Ghost-like hematopoietic cells
AFIP images
Myelocytes along endosteum of bone trabeculae: H&E and myeloperoxidase stain
Perivascular immature granulocytes
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Type I myeloblast
Type II myeloblast
Type III myeloblast
Blast (upper) and promyelocyte (lower)
Myeloblast (type not specified)
Promyelocytes: with Auer rods
Promyelocytes
3 myelocytes + 2 metamyelocytes (right and lower)
Neutrophilic myelocytes
Myelocyte and bands
Metamyelocytes
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Neutrophil
Details of granules
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Interaction of osteoblasts and hematopoietic stem cells
AFIP images
Osteoblasts in marrow smear
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Osteoblasts
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Colorized SEM
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Cross section
Bone resorptive cycle
AFIP images
Very large cell
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Osteoclasts
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Osteoclast
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50 year old man: rare pronormoblast forms
Large and megaloblastic pronormoblast forms
Giant cell with eosinophilic nuclear inclusion
B19+
B19+ cells in bone marrow biopsy
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Native parvovirus B19
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Aspirate smear shows few spicules
Pronormoblast with vacuoles
Occasional ringed sideroblasts (Prussian blue)
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Plasma cells
Plasma cells in myeloma
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Plasma cell without labels
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Lymph node biopsy
Differentiation of mature plasma cells
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Stages of plasma cell differentiation
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Plasma cells in bone marrow
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No erythroid precursors
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Q fever meningoencephalitis
Q fever pneumonia
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Fibrin ring granuloma with central fatty vacuoles
Liver: fibrin ring granuloma
Liver: doughnut granuloma
Cardiac valve
Liver: doughnut granuloma (arrow)
Cell lines infected with C. burnetii
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Within vacuole of host cell
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Chronic myelogenous leukemia
Refractory anemia with excess blasts
Refractory anemia with excess blasts in transformation
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Hyperlipidemia: cytoplasmic electron dense granules
"Finger print" arrangement of membranes
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Bone marrow aspirate
Decreased bone marrow cellularity
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Absent radius
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Fabry disease:
Kidney: podocytes are diffusely distended by intracytoplasmic vacuoles; scattered foam cells in interstitium
Kidney: PAS shows podocytes with foamy cell change
Lymph nodes: reactive hyperplasia
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Normal platelets
Platelets contain variable dense granules
Platelet undergoing spontaneous release
Cherry: 2022
Foucar: 2009
Foucar: 2017
Foucar: 2023
Hsi: 2017
Hudnall: 2019
IARC: 2017
Jaffe: 2016
Naeim: 2018
Wake: 2023
Wang: 2020
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