this clinical image based question appeared in need PG 2023 and I won want you to see the entire explanation of this particular question because I'm going to take you through a lot of important histological slides uh which are very frequently Asked in the examination so let's look at this question the question says that a 63-year-old male presented with complaint of fatigue and weakness and this happened over past 1 month so you ordered a peripheral SM and this is the picture you you get so the question asked which of the following is the the most likely genetic change associated with this patient and your options are translocation 922 translocation 1517 translocation 1114 and translocation 1118 so these are your options so let's look at what each of these genetic changes imply and in what specific condition can we see them so when we talk about translocation T 922 we are talking about Phil Delphia chromosome and can you name the condition where it is seen it is primarily seen in your CML and sometimes in Al but primarily it will be seen in your CML cases how about translocation of 1517 so again it is seen in AML can be seen from M1 to M3 but primarily in your M3 so it is primarily seen in your acute Pro Milotic leukemia okay what about 1114 so 1114 is seen in one of the non- Hotchkins Lymphoma specifically your mantal cell lymphoma how about 1118 so 1118 again is seen in one of the non Hotchkins Lymphoma and it is primarily seen in your folly C DM for okay and what is the specific uh you know image that is showing you so you can see these are basically your our RS okay and this is primarily seen in your AML t517 will be the correct answer so let me take you through each of these images and tell more about it so here in this image so it's a magnified version of this particular cell all these cell so it's a magnified version and what you see is basically this cytoplasmic inclusions okay and these cytoplasmic inclusions are basically called as or RS okay what are where they are seen in we have seen they are seen in AML AML we know there are several subtypes so it is generally seen in M1 to M3 but primarily in your M3 which is in acute Pro myotic leukemia okay then another important thing and uh another important thing is what they are made up of so they have basically enzymes okay crystallized enzymes and what are these enzymes so they can be myop peroxidases or other lysosomal enzymes and this is very very important because the you know Mass uh destruction of these cells is what leads to a very important complication in these AML patient that is DIC okay DIC because of the clotting Factor uh you know uh being activated because of these enzymes so DIC is very very common of these subtype because of these orid cells only and when you stain them how do you find so you can have crystallized granules okay which stain as you know elongated red or pink crystals so this is all about or red cells and we have learned a lot about AML in the specific lecture but this is a very very important clinical image let's look at this image I've told you that in this particular uh you know video I'll take you through a lot of important images so what is this can anyone tell me what is this so This basically is your classical re stoneberg cell also called as RS cell so we know it looks like an owl eye okay it looks an owl ey and where where is it seen so it is basically seen in your hot skins lymphoma we know that RS cells you know are of various subtypes like pleomorphic you can have lacunar you can have popcorn mummy there are various different types of RSL but primarily if you identify this image you will be able to answer most of the question another very important you know differential diagnosis of RSS so it is also seen in some solid cancers okay it is also seen in infectious mononucleosis okay or even in immunop plastic lymphoma okay so these are the differential diagnosis of RS CS RS cell very very important will you be able to identify it let's look at the next image so what do you see here so these are called as butex cells okay and you can see these butex cells in your follicular lymphoma okay which which is a kind of non- hodkin lymphoma okay let's look at this image so what can you see in this image this typically appearance you know it's like completely filled so this is called as star Sky appearance very easy to identify and primarily diagnostic of parets Tempa okay they are very very aggressive to these workit lymphomas further they are divided into endemic sporadic and HIV related so we know that endemic is one with the jaw swelling and all so we will not go into the details but this image you have to identify Starry Sky appearance let's look at the next image very easy to identify so we have got a something hairy projections and this this is what we see in your hairy cell leukemia so it's again A B cell tumor okay and this image remember it is seen in your phase contrast microscopy okay so this is hairy cell leukemia let's look at the next image so what can you see this image so this is basically called as what the image we will identify is at Hors shaped nucleus and this is seen in your anaplastic large cell lymphomas anaplastic large cell lymphomas now a very very important point which have been asked on anaplastic large cell lymphoma is they express cd30 and we have a lot of good anti- CD 30 molecules okay so they have very good prognosis because these CD4 you know expression of cd30 can be you know uh specifically Target by this anti cd30 uh molecules so now they have very good prognosis and what you can identify is this horseshoe shaped nucleus what is this so here what is this so this we call it as Seri Bri form nucleus which means like the conations of the brain okay this is seen in your cutaneous T Cell lymphomas okay again it's a CD4 tumor okay so cber from nucleus seen in your cutaneous T cell lymphoma this again image has been asked last multiple times so this is what you call as a tennis racket cells and this is seen in your Langer cell Hyo cytosis okay a very important question which has been asked is the kind of mutation which we see in this so VCB r a f mutation this has been asked quite a few times in past 2 3 years but very easy to identify that is tennis rack cells or Langer cell histiocytosis now what about this what about this looks like a flower looks like a flower okay so we call it as flower cell and it is seen in your adult t- cell leukemia easy to identify in the examination okay and now what about this so two images I have shown so first is this very very diagnostic so you have this you know cells which smudge out fragile cells so we what we call this as smudge cells or basket cells or even parachute cells parachute cells and all of these is seen in your chronic lymphocytic leukemia chronic lymphocytic leukemia another very important thing about the same image is we can see that all the cells almost look like each other so that is why these cells are called This is called as a Convent G appearance why Convent girl because in Convent what happens all the girls will be wearing exactly same dress so they look exactly same so that is why this is called as a Convent girl appearance we are going to see another appearance and this is a image of a lymph node biopsy and you can see there is a diffuse effacement of the lymph architecture so both these images basically relate to your CLL patient okay and the last image which I'm going to see you show you is this so what does this see it looks like the cytoplasm a lot of things have been you know what we call accumulated and this is what we called as pseudo Goucher cells we know in Goucher cells what will happen lot of you know G cere glucose cerebrosides get accumulated that is gure cells so here also there is an accumulation which looks like a pseudo gure cells and when is this condition seen this is seen in cm pseudo gure cell appearance now in this case we see that all the cells are in different stages of maturation and this is what we called as is college girl appearance let me show you you know another image so that you are going and this college girl appearance is seen in peripheral because different stages of maturation uh because there's no maturational arrest also named by another name that is flower garden appearance okay so these were very very important images let me quickly revise it again for you so that it's like you know uh very very clear for you uh just let me revise all the slides okay so this is odd cells very very easy to identify okay this is your RS cell again easy to identify this is your but cell again easy to identify uh this is your Starry Sky appearance easy to identify this is your hairy cell equia remember it's not in the staining it is the face contrast microscopy where you see these hairy cells this is your hhip toe nucleus that is seen in anaplastic larel lymphoma this is your cerum nucleus this is your backet racket appearance this is your flower you know shaped flower cells adult cell leukemia this is your CL where you see smudge cells and uh you know Convent curl appearance then again you can have diffuse easement of lymph node and finally this is the last image where you see pseudo gure cells and college C appearance all these images are super super important and I would really want you to save this video because if you know almost all H hematological cancers you know key images I have captured in this particular video