Correct!
4. Bone marrow aspiration / biopsy
The persistent, even worsening over the previous months, macrocytic anemia, in the context of the patient’s symptoms, raises the possibility of a bone marrow abnormality.
Bone marrow biopsy was performed and showed hypercellular bone marrow with atypical megakaryocytic hyperplasia, occasional granulocytic hypogranularity, mild basophilia, and 1-2% blasts. Dyserythropoiesis with multinucleation and internuclear bridges and nuclear fragmentation was noted. Cytogenic analysis showed 47XY, +8[20] karyotype and a Tier 1 mutation in U2AF1. Fluorescence in situ hybridization (FISH) showed trisomy 8. No evidence of plasma cell dyscrasia or lymphoma was seen, but the bone marrow biopsy findings were interpreted as suggestive of myeloid dysplasia, specifically myelodysplasia with multilineage dysplasia (MDS-MLD). Therapy with venetoclax and azacitidine was begun and stem cell transplant was discussed. Several months later the patient underwent repeat chest CT (Figure 5) for assessment of the effectiveness of antifungal therapy.
Figure 5. Left: Static images from axial unenhanced CT obtained 7 months after initial presentation. Right: Video of CT scan.
Which of the following represents an appropriate interpretationfor this examination? (Click on the correct answer to be directed to the ninth of fourteen pages).