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. Author manuscript; available in PMC: 2019 May 1.
Published in final edited form as: Mod Pathol. 2018 Jan 12;31(5):690–704. doi: 10.1038/modpathol.2017.182

FIGURE 2. Patient 7, Time course of laboratory and histopathologic features in a patient with simultaneously identified BCR-ABL1 and JAK2 V617F. Mixed morphologic features at both initial diagnosis and follow-up with progression to marrow failure.

FIGURE 2

A. Time course of BCR-ABL1 transcript levels (log scale), cytogenetic t(9;22) results (Cyto), JAK2 V617F status, treatment, peripheral blood counts, and bone marrow morphology, Nil = nilotinib. B. Bone marrow core biopsy at initial diagnosis (month 0) showing features of chronic myeloid leukemia and myelofibrosis. Hypercellular (top left), mixed population of small hypolobated megakaryocytes and larger forms with atypical morphology (bulbous "cloud-like" nuclei, hyperlobation) with some clustering (top right, lower). C. Bone marrow core biopsy following tyrosine kinase inhibitor therapy showing predominant features of myelofibrosis (month 31). Hypercellular (top left), marked granulocytic hyperplasia, increased atypical megakaryocytes with variably bulbous "cloud-like" morphology (top right), many intrasinusoidal megakaryocytes (bottom left), increased reticulin fibrosis, grade 2/3 (bottom right). D. Bone marrow core biopsy following tyrosine kinase inhibitor and hydroxyurea therapy (month 65). Hypocellular (~10%) (top), osteosclerosis and residual reticulin fibrosis (bottom).