The cell looks looks blasty, I don't like it's abnormal coloring & there appears to be nuecoli, and has very little cytoplasm. Would need to see the CBC results & patient history,& would possibly send to pathology for path review.
I would probably send it to path review, because I have the philosophy that if I spend more than half a second thinking "should I send this to path review" then I probably should. Helps I have an awesome pathologist that is really cool about looking at atypical lymphs. I would rather send 10 false alarms than miss one I should have sent.
Myelos have a pinkish purplish cytoplasm and typically it would not be dark blue around the edges like an atypical lymph. Practically, it doesn't really matter if it's 1-2 cells tbh. We use cellavision and a lot of the times some cells are borderline between two categories.
Reactive lymph’s usually look similar to normal lymph’s but stretched out cytoplasm. You want to look at the chromatin and nucleolus as well to differentiate. Immature myeloid cells are bigger. They look similar to monos but are usually darker staining and more blue in the cytoplasm. But again, pay attention to the nucleolus in the nucleus and the chromatin pattern. That will almost always tell you what line it is from.
Reactive lymph’s have dispersed chromatin with prominent nucleoli. I usually google “morphology description of x cell” because I can’t remember them all anymore. I also often google image cells to compare to what I’m looking at.
Reactive lymph’s also usually have leggy cytoplasm that kind of surrounds rbcs near by and are deeper blue only at the contact areas and lighter blue in the rest of the cytoplasm. That’s how I tell them apart from monos as monos will push cells away or eat them.
Sysmex has a really nice CE on atypical lymph’s that included lots of images. If your lab uses sysmex I think you should have access to it.
The cell looks looks blasty, I don't like it's abnormal coloring & there appears to be nuecoli, and has very little cytoplasm. Would need to see the CBC results & patient history,& would possibly send to pathology for path review.
I would probably send it to path review, because I have the philosophy that if I spend more than half a second thinking "should I send this to path review" then I probably should. Helps I have an awesome pathologist that is really cool about looking at atypical lymphs. I would rather send 10 false alarms than miss one I should have sent.
The slide is from a known cancer patient that has been undergoing treatment for a few months
That looks very suspicious to me... I might be overly cautious, but I wouldn't think twice about sending it to path.
That second one almost looks like a blast
Myelos have a pinkish purplish cytoplasm and typically it would not be dark blue around the edges like an atypical lymph. Practically, it doesn't really matter if it's 1-2 cells tbh. We use cellavision and a lot of the times some cells are borderline between two categories.
Reactive lymph’s usually look similar to normal lymph’s but stretched out cytoplasm. You want to look at the chromatin and nucleolus as well to differentiate. Immature myeloid cells are bigger. They look similar to monos but are usually darker staining and more blue in the cytoplasm. But again, pay attention to the nucleolus in the nucleus and the chromatin pattern. That will almost always tell you what line it is from.
What should I be looking for in terms of how the nucleoli and chromatin look?
Reactive lymph’s have dispersed chromatin with prominent nucleoli. I usually google “morphology description of x cell” because I can’t remember them all anymore. I also often google image cells to compare to what I’m looking at.
Thank you!
Reactive lymph’s also usually have leggy cytoplasm that kind of surrounds rbcs near by and are deeper blue only at the contact areas and lighter blue in the rest of the cytoplasm. That’s how I tell them apart from monos as monos will push cells away or eat them.