Blood Res 2017; 52(4): 240-240  https://doi.org/10.5045/br.2017.52.4.240
Pseudo-Chediak-Higashi inclusions in a case of acute lymphoblastic leukemia
Sarita Pradhan*, and Sima Chauhan

Lab Hematology Division, Department of Pathology, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, India.

Correspondence to: Sarita Pradhan, M.D., Lab Hematology, Institute of Medical Sciences and Sum Hospital, Kalinganagar, Bhubaneswar 751003, India, dr.sarita26@gmail.com
Received: December 31, 2016; Revised: February 25, 2017; Accepted: April 8, 2017; Published online: December 26, 2017.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 

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A 57-year-old man presented with fever and bilateral cervical lymphadenopathy for 3 months. The hemoglobin level was 6.3 g/dL, with a total leucocyte count of 1,180/µL and platelet count of 270×103/µL. The differential count showed 90% lymphocytes, 6% neutrophils, and 4% blasts. Bone marrow (BM) aspiration was difficult and the sample was hemodiluted, with 59% blasts in the differential count. The blasts were negative for Sudan Black B. Many blasts showed eosinophilic, hyaline inclusion-like bodies resembling Chediak-Higashi granules (A, B; BM aspiration, Leishman-Giemsa, ×1,000). Flow cytometry analysis revealed a distinct population in the blast window that was positive for TdT, HLA-DR, cCD22, and cCD79a, with co-expression of CD10 and CD19. There was an aberrant expression of CD33. A final diagnosis of acute lymphoblastic leukemia with pseudo-Chediak-Higashi inclusions was made. Pseudo-Chediak-Higashi granules are giant eosinophilic cytoplasmic inclusions in myeloblasts or myeloid precursors and resemble the inclusions found in inherited Chediak-Higashi syndrome. They are occasionally encountered in acute myeloid leukemia but are very rare in acute lymphoblastic leukemia. Very few cases have been reported.



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