Gallery: AML with monocytic maturation
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Appearances in blood
Some or all monoblasts may show more obvious maturation - look for a convoluted nucleus and cytoplasmic features such as metachromatic granules and vacuoles (cells that have the features of promonocytes are regarded as blast equivalents). This form of AML may superficially resemble the variant form of APL.
Other aspects that may be present
This form of AML may have very high circulating blast cell counts with infiltration of tissues and a coagulopathy may be seen. The appearances of cells in marrow or blood may differ with cells in blood appearing more mature. The translocation t[11q23] may be more frequently seen in this form of AML.
Image: two blast cells with monocytic differentiation. One remains quite primitive although there is a degree of nuclear convolution, the other has a far more monocytic appearance (although the nuclear chromatin confirms blast nature). Note also the agranular dysplastic neutrophil.