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A 32 -year-old female patien t presen ts with fatigue and dyspnea. She appears pale, but has an otherwise normal physical examination. Complete blood cou nt shows leukocyte count 1 95 .000/,LLL. hemoglobin 6.8 g/dl, and platelet count 1 0.000/,LLL. The periph- eral blood smear is shown below.
Based on the following peripheral blood smear and bone marrow images, what is the most likely diagnosis?
- Acute myeloid leukemia with t(8:21)
- Acute myeloid leukemia monosomy -5 or -7
- Acute myeloid leukemia with inv(1 6)
- Acute myeloid leukemia with t(9;11)
Medicine
C. The blood smear shows immature appearing monocytes as well as myeloid blasts. The bone marrow aspirate shows eosinophilic myeloid precursors with coarse basophilic granules. Such findings are characteristic of AML with inv(16). FISH for inv(16) was positive and confirmed a diag-nosis of AML inv(l 6). The inv(l6) is a pericentric inversion of chromosome 16, involving core binding factor and muscle myosin heavy chain genes. AML with inv(l6) is recognized as a distinct clinical entity with a favorable prognosis and accounts for 6% to 8% of all cases of AML. As shown in the blood smear, there is usually leukocytes with monocytic and granulocytic differentiation. In addition, the bone marrow shows a variable number of immature eosinophils with striking granules. AML with t(8;2 1) also has a favorable prognosis, but has a different morphologic appearance, which, in many cases, includes the presence of needle-like Auer rods. AML with monosomy -5 or -7 and AML with t(9;11) are therapy-related and carry a relatively poor prognosis (NEJM. 1983;309:630-636).
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