Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
A 52-year-old woman with a history of hepatocellular carcinoma with bone metastasis (T6, L5-S1) was referred for pancytopenia after undergoing radiation therapy and transarterial chemoembolization. Splenomegaly and compact lipiodol retention in liver segment V was found on computed tomography. Her hemoglobin level was 10.8 g/dL; platelet count, 23,000/µL; white blood cell count, 1.9×103/µL; and mean corpuscular volume, 87.1 fL. The leukocyte differential smear revealed 48.6% segmented neutrophils, with toxic signs; 24.4% lymphocytes; 24.4% monocytes; 1.3% eosinophils; and 1% basophils. Normocytic normochromic anemia with frequent fragmented red blood cells was diagnosed. A bone marrow (BM) aspirate revealed trilineage hematopoietic components with prominent toxic granules in granulocytic series and poorly stained acellular material. BM biopsy showed a hypocellular marrow (10% cellularity); remarkable fat atrophy; and extracellular deposits of amorphous, smooth, pinkish (