GrannyBarb and Art's

31 August 1998 -Biopsy Slides

This page and the others like it including the slides and the flow cytometry reports have been added to Grannybarb's story at the request of Gerald Marti, M.D., NIH, who hopes that they will provide additional insight for professionals and patients who may be interested in the technical part of CLL. For those who are simply reading the' story, please feel free to skip this part.

BM Bx BM94-233 received from MD Anderson showed 75% of bone marrow space occupied by cells consistent with CLL. These slides were returned to MD Anderson. That study was done prior to 6-10-94.

Figure 1.Biopsy #1 after MD Anderson done at SJMMC is labled BM94-323. The procedure appears to have been done on or about 08/26/94. Upper right and left panels are low power views of the H and E of a small biopsy that consisted of six small pieces. The two shown are representative even though there are cutting and staining artifacts and perhaps suboptimal fixation. The lymphoid infiltrate is patchy and focally diffuse and the pattern was both para-trabecular and intra-trabecular. Lower left panel is a low power view of a single spicule chosen to demonstrate the increased mast cells often seen in chronic lymphoproliferative disease (LPD). The middle lower panel is a 20x view of two large lymphoid aggregates and one of these is shown in the right lower panel (63x oil). It appears typical of the cells seen in CLL when sections are thickly cut, and or overstained. Overall there is an ill defined nodular pattern composed of small lymphocytes involving approximately 50% of the marrow with trilineage maturation and absence of other marrow abnormalities. Reticulin stains were pending. In addition to lymphocytes, a few prolymphocytes were noted on the aspirate smear. Iron stores were said to be absent.

Figure 2 BM97-151 (date of procedure 04/11/97) is shown in the upper panel. This is more ample sample but cutting artifacts are seen. The mixed nodular and diffuse pattern is again seen and the lymphoid infiltrate appears to be more dense. Of the next lower nine smaller panels, the left upper most is a low power view of one of the denser aggregates with its associated cutting artefact. The remaining eight panels (43x oil) are a series of representative fields showing the small lymphocyte infiltration admixed with prolymphocytes and mitoxic figures were rare.

Figure 3.BM97-151, Aspirate Smear (date of procedure 04/11/97. This composite consists of twelve panels. The upper left and middle panels are 20x and 5x respectively and demonstrate the magnitude of the lymphoid infiltrate again with mast cells in the aspirate smear. The remainder of the selected fields are 100x oil and were selected with the intention of demonstrating the prolymphocytoid component of this biopsy.

Figure 4. BM97-151 PBS (date of procedure 04/11/97. This is a composite of representative lymphoid cells seen on the accompanying blood film. At that time the WBC was 4,600 while platelets were 130,000. Their plasmacytoid appearance and an occasional binucleated lymphoid cell was noted.

Figure 5. BM97-218 (date of procedure 05/23/97). It is my understanding that this bone marrow biopsy was obtained after the last course of chemotherapy prior to an autologous bone marrow transplant. The amount of lymphoid involvement (upper panel) was significantly decreased and estimated to be 15%. The three lower panels were selected to be representative of the area of lymphoid involvement. There is a suggestion that prolymphocytes are focally increased. An aspirate smear was hypocellular and unsuitable to perform a differential count but scattered lymphocytes were estimated to be less than 10%.

Figure 6. BM97-218 PBS (date of procedure 05/23/97. The WBC was 3500 and slightly left shifted and occasional Pelger-Huet cells were noted. The lymphocytes that could be photographed appear to be reactive.

Bloodwork from 1989 through 1994

Bloodwork from 1995 through 1998

Bloodwork SJMMC, ST. Louis, 1996-1997

Dana Farber Cancer Center 1997-98

Just the BMT Bloodwork, June 1997

Post BMT Pathology at DFCI, Boston

GrannyBarb's Chronic Lymphocytic Leukemia Story, page 1

GrannyBarb's Chronic Lymphocytic Leukemia Story, page 2

GrannyBarb's Chronic Lymphocytic Leukemia Story, page 3

Art's Acute Myeloid Leukemia Story

GrannyBarb and Art's Leukemia Links Site Map

Copyright ©1998 Barbara B. Lackritz (alias GrannyBarb)
This Page was created Monday, September 01, 1998
Last modified: Mon September 01,1998