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IMAGE IN HEMATOLOGY
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 36

Acute myelomonocytic leukemia demonstrating erythrophagocytosis on cerebral spinal fluid cytology


1 Department of Haematology, Monash Health, Melbourne, Australia
2 Department of Haematology, Monash Health, Melbourne; School of Clinical Sciences, Monash Health, Monash University, Clayton, Victoria, Australia

Date of Web Publication30-Apr-2019

Correspondence Address:
Prof. Hiu Lam Agnes Yuen
Monash Medical Centre, 246 Clayton Rd., Clayton VIC 3168
Australia
Jake Shortt
Monash Medical Centre, 246 Clayton Rd., Clayton VIC 3168
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_2_19

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How to cite this article:
Agnes Yuen HL, Shortt J. Acute myelomonocytic leukemia demonstrating erythrophagocytosis on cerebral spinal fluid cytology. J Appl Hematol 2019;10:36

How to cite this URL:
Agnes Yuen HL, Shortt J. Acute myelomonocytic leukemia demonstrating erythrophagocytosis on cerebral spinal fluid cytology. J Appl Hematol [serial online] 2019 [cited 2019 May 20];10:36. Available from: http://www.jahjournal.org/text.asp?2019/10/1/36/257467

A 73-year-old male with newly diagnosed acute myelomonocytic leukemia with complex karyotype (46, X,-Y, del(8)(q24q24),+r(5)/47, sl,+r(2)/48, sdl,+r(13).ish del(8)(MYC-), r(MYC amp)) was referred with papilledema on day 11 of cytarabine and thioguanine induction. His complete blood count showed hemoglobin 95 g/L, leukocytes 4.6 × 109/L, and platelets 29 × 109/L, with no circulating blasts evident on microscopic film review.

His initial diagnostic specimens demonstrated prominent erythrophagocytosis on peripheral blood and bone marrow aspirate ([Figure 1]. Panel A and B; May-Grunwald Giemsa (MGG) stain, original magnification ×1000). Following a normal magnetic resonance imaging scan, a lumbar puncture was performed; the cerebrospinal fluid (CSF) had 32 × 106/L leukocytes with 14 × 106/L red cells. A cytological preparation demonstrated blasts, some with erythrophagocytosis ([Figure 1]. Panel C; MGG stain, original magnification ×400).
Figure 1: Acute myelomonocytic leukemia demonstrating erythrophagocytosis on peripheral blood (Panel A), bone marrow aspirate (Panel B) and cerebral spinal fluid cytology (Panel C)

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The patient received additional intrathecal chemotherapy and achieved both marrow and CSF complete remission.

Involvement of the central nervous system by acute myeloid leukemia is uncommon but well recognized in the context of monocytic differentiation. Erythrophagocytosis in this CSF specimen is putatively attributable to an ex vivo interaction between blasts and red cells introduced at the time of lumbar puncture.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


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