Acute Myeloid Leukemia with Cup-Like Nuclear Inclusions, and FLT3-ITD and NPM1 Mutations

A 69-year-old man presented to an outside hospital with fatigue, fevers, altered mental status, and dyspnea. Laboratory testing revealed a white blood cell count of 231 × 103/μL with 88% blasts, hemoglobin of 6.2 g/dL, and platelet count of 80 × 103/μL. Bone marrow biopsy confirmed a diagnosis of acute myeloid leukemia (AML) with flow cytometric analysis demonstrating two abnormal myeloblast populations, the first expressing CD11b (partial), CD13, CD33, CD45 (dim), CD64, CD117, and HLA-DR and the other CD10, CD11b, CD13 (subset), CD14, CD15, CD33, CD45 (moderate to bright), CD64, and HLA-DR. Both populations showed heterogeneous expression of myeloperoxidase and were negative for CD34 expression. Karyotype and FISH studies revealed no chromosomal abnormalities.