Combined Hematology II
A 48-year-old man has experienced increasing malaise and difficulty concentrating at work for the past 6 months. On physical examination he has splenomegaly but no lymphadenopathy. He is afebrile. Laboratory studies show Hgb 12.0 g/dL, Hct 35.8%, MCV 92 fL, platelet count 390,000/uL, and WBC count 190,000/uL with differential count 73 neutrophils, 12 bands, 6 metamyelocytes, 2 myelocytes, 2 myeloblasts, and 5 lymphocytes. The leukocyte alkaline phosphatase (LAP) score is very low. A bone marrow biopsy is performed. Which of the following microscopic findings is most likely to be found in this biopsy?
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