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. 2018 Aug 22;8(9):82. doi: 10.1038/s41408-018-0120-5

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© The Author(s) 2018

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — a Peripheral blood smear of the patient with a diagnosis of chronic myelomonocytic leukemia, demonstrating atypical dysplastic granulocytes, atypical monocytes, and a blast. Wright Giemsa stain, ×400 magnification. b Bone marrow core biopsy of the patient with chronic myelomonocytic leukemia, demonstrating a hypercellular marrow (90%), with dysplastic megakaryocytes. Hematoxylin and eosin, ×100 magnification. c Butyrate esterase (brown) and chloroacetate esterase (blue) cytochemical dual stain, demonstrating increased butyrate esterase monocytes and dual esterase-positive bone marrow monocytes, suggestive of monocytic dysplasia (×400 magnification). d (Left) Bone marrow core biopsy, TCL1 immunohistochemistry, demonstrating TCL1-positive plasmacytoid dendritic cell nodules (×200 magnification). (Right) Bone marrow core biopsy, CD123 immunohistochemistry, demonstrating CD123-positive plasmacytoid dendritic cell nodules (×200 magnification). e (Left) Bone marrow biopsy, TCL1 immunohistochemistry, demonstrating diffusely TCL1-positive blasts, suggestive of a blastic plasmacytoid dendritic cell neoplasm (×100 magnification). (Right) Bone marrow core biopsy, CD123 immunohistochemistry, demonstrating diffusely positive CD123 blasts, suggestive of a blastic plasmacytoid dendritic cell neoplasm (×100 magnification). f Bone marrow aspirate obtained at the time of disease transformation demonstrating hand mirror-shaped blastic cells, characteristic for blastic plasmacytoid dendritic cell neoplasms. Wright Giemsa, ×1000 magnification