Case study: Finding leukemia cells in cerebrospinal fluid in patient with acute myelomonocytic leukemia

DOI
  • OSHIRO Yusuke
    Central Clinical Laboratory, National Center, for Global Health and Medicine
  • TEZUKA Shunsuke
    Central Clinical Laboratory, National Center, for Global Health and Medicine
  • HANAI Arisa
    Central Clinical Laboratory, National Center, for Global Health and Medicine
  • TSUCHIHASHI Etsuko
    Central Clinical Laboratory, National Center, for Global Health and Medicine
  • HASEGAWA Tatsuro
    Central Clinical Laboratory, National Center, for Global Health and Medicine
  • DOI Seiichi
    Central Clinical Laboratory, National Center, for Global Health and Medicine
  • MIYAZAKI Sumio
    Central Clinical Laboratory, National Center, for Global Health and Medicine

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Other Title
  • 髄液中に白血病細胞が検出された急性骨髄単球性白血病の1例

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A one-year-old male patient of a pediatric outpatient clinic presented with symptoms of cough, fever, headache, leg pain and walking abnormality. Although abnormal cells were not found via a hemogram, scattering of enlarged atypical cells, which were characterized by an increased nuclear-cytoplasmic ratio, prominent nucleoli and finely divided, threadlike chromatin with very little granulation, was detected by Samson staining in the cerebrospinal fluid. Further cerebrospinal fluid smear analysis was required to diagnose suspected hematologic disease; thus, the May-Grunwald-Giemsa stain, peroxidase stain and double esterase stain were used. Blastoid cells were detected in the May-Grunwald-Giemsa-stained smear. The cells reacted to nonspecific esterase and were inhibited by the addition of sodium fluoride to these cells; additionally, they were not stained by specific esterase or peroxidase. The result was reported immediately and the patient was diagnosed as having acute myelomonocytic leukemia (M4 in FAB classification). For this patient, the use of hematological examination techniques in cerebrospinal fluid studies enabled us to identify acute leukemia promptly.

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