Just as there are many different types of myeloid cells (neutrophils, red cells, monocytes, eosinophils, basophils), there are many different types of acute myeloid leukemia (AML). Two types of AML are composed almost entirely of cells of the monocytic series: acute monoblastic leukemia and acute monocytic leukemia. In both of these types of AML, at least 80% of the leukemic cells are from the monocytic series (monoblasts, promonocytes, and monocytes). In acute monoblastic leukemia, most of these cells are monoblasts, and in acute monocytic leukemia, most of these cells are promonocytes. Promonocytes have a very characteristic appearance, as shown above. They have nuclei that show a delicate folding pattern, almost like a piece of tissue paper that has been crumpled a bit. If you had a case of acute leukemia and most of the cells looked like this, you would think about acute monocytic leukemia – and you’d get an NSE to prove it.
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