1/2). 70yoM with 1 year hx of thrombocytosis and anemia, no splenomegaly, BCR/ABL(-),MPL(+). What is your dx? (Answer poll) 
(2/2).What is the most likely diagnosis? (See case description)
1/4) This is a case of early PMF. The picture shows a hypercellular marrow with atypical megakaryocytes in dense clusters, and left-shifted granulocytic hyperplasia.
2/4) The key in this case is the increased marrow cellularity. Atypical megs + hypercellular marrow + MPL (+) + anemia = PMF, regardless of reticulin!
3/4) In ET, only the megakaryocytes are increased in number (not the other lineages). The marrow then appears normocellular. Meg clusters, if present, are loose. There are no hyperchromatic/hypolobated megs.
4/4) Finally, PV is not the answer. Positive MPL mutation is seen in PMF or ET, but not in PV. Also anemia is unusual at presentation. Again, this is PMF, regardless of reticulin, but here it is showing fibrosis grade 2. Therefore, an early case of overt PMF. #hemepath
❓Test your knowledge❓=> What is the frequency of the MPL mutation in PMF? 🤓 #Hemepath #pathBoards
• • •
Missing some Tweet in this thread? You can try to
force a refresh
