Figure.
Morphological features of myelodysplasia and myeloproliferation are
evident. Ultrasound images of the left calf demonstrating a posterior
and medial complex fluid collection (yellow arrows) consistent with a
hematoma is shown (panel A). Ultrasound image of the right popliteal
vein (red arrow) demonstrating circumferential thickening (yellow
arrows) consistent with thrombus possibly of chronic etiology (panel B).
Evidence of dyshematopoiesis is shown (panels C-E x50 magnification).
Accordingly, normoblasts with irregular nuclear contours, pelgeroid
neutrophils and small hypolobated megakaryocytes are seen. Features of a
myeloproliferative neoplasm includes presence of large megakaryocytes
with so called “staghorn nuclei” (panel F X 50 magnification) showing
loose cellular aggregates (trephine H&E, X20 and CD61 X10
magnification). Two ring sideroblasts are shown (panel I, Perl’s
Prussian blue stain for iron X 100 magnification).