Magic hand-mirror cells

A 75-year-old man with a diagnosis of chronic myelomonocytic leukemia evolved with asthenia and worsening cytopenias. A complete blood count showed hemoglobin 9.2 g/dL, neutrophils 0.5 × 109/L, monocytes 1.3 × 109/L, and platelets 20 × 109/L. Peripheral blood smear revealed 35% blast cells with a moderate nuclear:cytoplasmic ratio and one or more nucleoli. A high proportion of blast cells showed a hand-mirror morphology characterized by a cytoplasmic tail extending out from one pole of the nucleus and harboring a few azurophilic granules and Auer rods.

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Magic mirror in my hand, which is the lineage in the end? A case of acute leukemia with hand-mirror cells

Source: Blood
Image credits: ASH Image bank