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 Tracy I. George
Daniel A. Arber
Editors

Atlas of
Bone Marrow
Pathology

123
Atlas of Anatomic Pathology

Series Editor
Liang Cheng
Indianapolis, Indiana
USA
This Atlas series is intended as a “first knowledge base” in the quest for diagnosis of usual and
unusual diseases. Each atlas will offer the reader a quick reference guide for diagnosis and
classification of a wide spectrum of benign, congenital, inflammatory, nonneoplastic, and
neoplastic lesions in various organ systems. Normal and variations of “normal” histology will
also be illustrated. Each atlas will focus on visual diagnostic criteria and differential diagnosis.
It will be organized to provide quick access to images of lesions in specific organs or sites. Each
atlas will adapt the well-known and widely accepted terminology, nomenclature, classification
schemes, and staging algorithms. Each volume in this series will be authored by nationally and
internationally recognized pathologists. Each volume will follow the same organizational
structure. The first Section will include normal histology and normal variations. The second
Section will cover congenital defects and malformations. The third Section will cover benign
and inflammatory lesions. The fourth Section will cover benign tumors and benign mimickers
of cancer. The last Section will cover malignant neoplasms. Special emphasis will be placed on
normal histology, gross anatomy, and gross lesion appearances since these are generally lacking
or inadequately illustrated in current textbooks. The detailed figure legends will concisely
summarize the critical information and visual diagnostic criteria that the pathologist must
recognize, understand, and accurately interpret to arrive at a correct diagnosis.This book series
is intended chiefly for use by pathologists in training and practicing surgical pathologists in
their daily practice. The atlas series will also be a useful resource for medical students,
cytotechnologists, pathologist assistants, and other medical professionals with special interest
in anatomic pathology. Trainees, students, and readers at all levels of expertise will learn,
understand, and gain insights into the complexities of disease processes through this
comprehensive resource. Macroscopic and histological images are aesthetically pleasing in
many ways. This new series will serve as a virtual pathology museum for the edification of our
readers.

More information about this series at http://www.springer.com/series/10144

Tracy I. George • Daniel A. Arber
Editors

Atlas of Bone Marrow

Pathology
Editors
Tracy I. George Daniel A. Arber
Department of Pathology Department of Pathology
University of New Mexico School of Medicine The University of Chicago
Albuquerque, NM, USA Chicago, IL, USA

Atlas of Anatomic Pathology

ISBN 978-1-4939-7467-2    ISBN 978-1-4939-7469-6 (eBook)
https://doi.org/10.1007/978-1-4939-7469-6

Library of Congress Control Number: 2017962322

© Springer Science+Business Media, LLC 2018

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
express or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Printed on acid-free paper

This Springer imprint is published by Springer Nature

The registered company is Springer Science+Business Media, LLC
The registered company address is: 233 Spring Street, New York, NY 10013, U.S.A.
Thank you, Chris, for your unwavering support and understanding.
Tracy I. George
To Carol, James, and William.
Daniel A. Arber
Series Preface

One Picture Is Worth Ten Thousand Words. (Frederick Barnard, 1927)

Remarkable progress has been made in anatomic and surgical pathology during the last 10
years. The ability of surgical pathologists to reach a definite diagnosis is now enhanced by
immunohistochemical and molecular techniques. Many new clinically important histopatho-
logic entities and variants have been described using these techniques. Established diagnostic
entities are more fully defined for virtually every organ system. The emergence of personalized
medicine has also created a paradigm shift in surgical pathology. Both promptness and preci-
sion are required of modern pathologists. Newer diagnostic tests in anatomic pathology, how-
ever, cannot benefit the patient unless the pathologist recognizes the lesion and requests the
necessary special studies. An up-to-date atlas encompassing the full spectrum of benign and
malignant lesions, their variants, and evidence-based diagnostic criteria for each organ system
is needed. This atlas is not intended as a comprehensive source of detailed clinical information
concerning the entities shown. Clinical and therapeutic guidelines are served admirably by a
large number of excellent textbooks. This atlas, however, is intended as a “first knowledge
base” in the quest for definitive and efficient diagnosis of both usual and unusual diseases.
The Atlas of Anatomic Pathology is presented to the reader as a quick reference guide for
diagnosis and classification of benign, congenital, inflammatory, nonneoplastic, and neoplastic
lesions organized by organ systems. Normal and variations of “normal” histology are illus-
trated for each organ. The atlas focuses on visual diagnostic criteria and differential diagnosis.
The organization is intended to provide quick access to images and confirmatory tests for each
specific organ or site. The atlas adopts the well-known and widely accepted terminology,
nomenclature, classification schemes, and staging algorithms.
This book series is intended chiefly for use by pathologists in training and practicing surgi-
cal pathologists in their daily practice. It is also a useful resource for medical students, cyto-
technologists, pathologist assistants, and other medical professionals with special interest in
anatomic pathology. We hope that our trainees, students, and readers at all levels of expertise
will learn, understand, and gain insight into the pathophysiology of disease processes through
this comprehensive resource. Macroscopic and histological images are aesthetically pleasing
in many ways. We hope that the new series will serve as a virtual pathology museum for the
edification of our readers.

Indianapolis, IN, USA Liang Cheng

vii
Preface

We developed this atlas in order to provide a practical tool for the practicing pathologist and
trainees in the field. Using experts in the field of diagnostic hematopathology, we have crafted
individual chapters comprised of numerous high-quality images, useful tables, and diagrams
that illustrate areas of diagnostic concern for pathologists, contrasting problem areas and mor-
phologic mimics, as well as discussing the latest classification of neoplasms.
Our intent is not to create exhaustive, lengthy treatises on each disease entity. Instead, this
atlas contains helpful hints from seasoned diagnosticians about how they approach an indi-
vidual patient’s biopsy and thus encompasses multiple modalities, from cytomorphology and
histopathology to flow cytometry and genetic testing.
Key references are provided to help guide the reader and provide a starting point for further
education. Our final result is an atlas of bone marrow pathology that can be used daily, from
troubleshooting of difficult cases to recognition of unusual entities.
Please enjoy!

Albuquerque, NM, USA Tracy I. George

Chicago, IL, USA Daniel A. Arber

ix
Contents

1 Normal Bone Marrow�����������������������������������������������������������������������������������������������    1

Heesun J. Rogers
2 Reactive Changes �����������������������������������������������������������������������������������������������������   13
Rebecca L. King and Matthew T. Howard
3 Post-therapy Marrow Changes�������������������������������������������������������������������������������   27
Jason H. Kurzer and Olga K. Weinberg
4 Constitutional, Metabolic, and Related Disorders�������������������������������������������������   33
Kristian T. Schafernak and Katherine R. Calvo
5 Bone Marrow Infections�������������������������������������������������������������������������������������������   67
Ahmad Monabati, Girish Venkataraman, and Perikala Vijayananda Kumar
6 Bone Marrow Lymphoma ���������������������������������������������������������������������������������������   77
Megan Parilla and Girish Venkataraman
7 Plasma Cell Neoplasms��������������������������������������������������������������������������������������������� 103
Carla S. Wilson
8 Immunodeficiency-Associated Lymphoproliferative Disorder����������������������������� 117
Juehua Gao and Yi-Hua Chen
9 Lymphoblastic Leukemia/Lymphoma ������������������������������������������������������������������� 129
Qian-Yun Zhang
10 Myelodysplastic Syndrome��������������������������������������������������������������������������������������� 159
Sandeep Gurbuxani
11 Acute Myeloid Leukemia����������������������������������������������������������������������������������������� 173
Daniel A. Arber
12 Myeloid Proliferations of Down Syndrome ����������������������������������������������������������� 193
Lee J. McGhan and Maria A. Proytcheva
13 Acute Leukemias of Ambiguous Lineage��������������������������������������������������������������� 199
Min Shi and Kaaren K. Reichard
14 Histiocytic Disorders������������������������������������������������������������������������������������������������� 211
Payal Sojitra and Tracy I. George
15 Myeloproliferative Neoplasms and Mastocytosis��������������������������������������������������� 223
Luke R. Shier and Tracy I. George

xi
xii Contents

16 Myeloid and Lymphoid Neoplasms with Eosinophilia ����������������������������������������� 257

Joanna M. Chaffin and Natasha Marie Savage
17 Myelodysplastic/Myeloproliferative Neoplasms (MDS/MPN)����������������������������� 267
Aaron Paul Rupp and Devon Chabot-Richards
18 Metastatic Tumors in the Bone Marrow����������������������������������������������������������������� 277
Mohammad Vasef

Index����������������������������������������������������������������������������������������������������������������������������������� 289
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by to 250