images and diagnosis Alveolar rhabdomyosarcoma masquerading as Burkitt’s lymphoma in bone marrow IK Tailor
a,*
, I Motabi a, N Alshehry a, S Zaidi a, L Algwaiz
b
a Department of Adult Haematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh 11525, Saudi Arabia, of Haematopathology, King Fahad Medical City, Riyadh 11525, Saudi Arabia
b
Department
* Corresponding author Æ Received for publication 31 December 2014 Æ Accepted for publication 6 January 2015 Hematol Oncol Stem Cell Ther 2015; xx(xx): xxx–xxx ª 2015 King Faisal Specialist Hospital & Research Centre. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). DOI: http://dx.doi.org/10.1016/j.hemonc.2015.01.001
A
sixteen-year-old male student with no significant medical history presented with abdominal pain experienced over a period of two months. He was found to have pancytopenia, raised lactate dehydrogenase, and markedly raised direct bilirubin. Imaging studies revealed large pancreatic mass causing common bile duct obstruction with associated splenomegaly and para-aortic lymphadenopathy. There was a paraspinal mass at the lower thoracic
level, too. Blood film revealed occasional blast-like cells. Bone marrow aspirate revealed intermediatesized, blast-like cells with high nucleocytoplasmic ratio and cytoplasmic vacuolation, initially thought to be Burkitt’s lymphoma (Fig. 1A). However, flow cytometry did not reveal the same. Immunohistochemistry was negative for CD45, CD10, TdT, CD99, cytokeratin, chromogranin, but positive for vimentin and myogenin (Fig. 1B). Biopsy from
(A)
(B) Vimenn
Myogenin
Fig. 1. (A) Bone marrow aspirate. (B) Immunohistochemistry on bone marrow.
Hematol Oncol Stem Cell Ther xx(xx)
xxx Quarter 2015
1
images and diagnosis paraspinal mass showed diffuse sheets of small round cells with high nucleocytoplasmic ratio and high mitotic rate. Some cells showed focal alveolar arrangement, revealing the same pattern as bone marrow on immunohistochemistry, and thus confirming alveolar rhabdomyosarcoma.
2
ALVEOLAR RHABDOMYOSARCOMA IN BONE MARROW
CONFLICT OF INTEREST STATEMENT We have no conflict of interest to declare.
Hematol Oncol Stem Cell Ther xx(xx)
xxx Quarter 2015
a,*
, I Motabi a, N Alshehry a, S Zaidi a, L Algwaiz
b
a Department of Adult Haematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh 11525, Saudi Arabia, of Haematopathology, King Fahad Medical City, Riyadh 11525, Saudi Arabia
b
Department
* Corresponding author Æ Received for publication 31 December 2014 Æ Accepted for publication 6 January 2015 Hematol Oncol Stem Cell Ther 2015; xx(xx): xxx–xxx ª 2015 King Faisal Specialist Hospital & Research Centre. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). DOI: http://dx.doi.org/10.1016/j.hemonc.2015.01.001
A
sixteen-year-old male student with no significant medical history presented with abdominal pain experienced over a period of two months. He was found to have pancytopenia, raised lactate dehydrogenase, and markedly raised direct bilirubin. Imaging studies revealed large pancreatic mass causing common bile duct obstruction with associated splenomegaly and para-aortic lymphadenopathy. There was a paraspinal mass at the lower thoracic
level, too. Blood film revealed occasional blast-like cells. Bone marrow aspirate revealed intermediatesized, blast-like cells with high nucleocytoplasmic ratio and cytoplasmic vacuolation, initially thought to be Burkitt’s lymphoma (Fig. 1A). However, flow cytometry did not reveal the same. Immunohistochemistry was negative for CD45, CD10, TdT, CD99, cytokeratin, chromogranin, but positive for vimentin and myogenin (Fig. 1B). Biopsy from
(A)
(B) Vimenn
Myogenin
Fig. 1. (A) Bone marrow aspirate. (B) Immunohistochemistry on bone marrow.
Hematol Oncol Stem Cell Ther xx(xx)
xxx Quarter 2015
1
images and diagnosis paraspinal mass showed diffuse sheets of small round cells with high nucleocytoplasmic ratio and high mitotic rate. Some cells showed focal alveolar arrangement, revealing the same pattern as bone marrow on immunohistochemistry, and thus confirming alveolar rhabdomyosarcoma.
2
ALVEOLAR RHABDOMYOSARCOMA IN BONE MARROW
CONFLICT OF INTEREST STATEMENT We have no conflict of interest to declare.
Hematol Oncol Stem Cell Ther xx(xx)
xxx Quarter 2015
