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Auer rod-like inclusions in marginal zone lymphoma: a potential diagnostic pitfall
Nour Louati1,2, Imen Krichen3,4, Ines Jedidi5,6
1Laboratory of Hemobiology, Regional Blood Transfusion Center, Sfax, Tunisia.
Abstract:
A 47-year-old man presented with leukocytosis and absolute lymphocytosis. Peripheral blood smear examination revealed atypical lymphoid cells containing striking Auer rod-like cytoplasmic inclusions, creating a strong morphologic impression of acute promyelocytic leukemia. However, flow cytometry demonstrated a mature monoclonal B cell population lacking myeloid differentiation, and bone marrow biopsy established the diagnosis of marginal zone lymphoma. This rare case highlights a major diagnostic pitfall and underscores that Auer rod-like inclusions are not exclusively restricted to myeloid neoplasms.
Insights
A rare case of marginal zone lymphoma mimicked acute promyelocytic leukemia due to atypical lymphoid cells with Auer rod-like inclusions. This highlights a diagnostic pitfall, showing these inclusions can occur outside myeloid neoplasms.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Peripheral blood smear examination is crucial for diagnosing hematologic malignancies.
- Auer rods are characteristic cytoplasmic inclusions found in myeloid blasts, strongly suggesting acute promyelocytic leukemia.
- Diagnostic challenges arise when atypical morphologic features mimic other hematologic conditions.
Purpose of the Study:
- To report a rare case of marginal zone lymphoma presenting with morphologic features mimicking acute promyelocytic leukemia.
- To emphasize the importance of comprehensive diagnostic workup beyond initial morphologic findings.
- To highlight that Auer rod-like inclusions are not exclusive to myeloid neoplasms.
Main Methods:
- Peripheral blood smear examination for morphologic assessment.
- Flow cytometry for immunophenotypic analysis of lymphoid and myeloid populations.
- Bone marrow biopsy for histopathological evaluation and definitive diagnosis.
Main Results:
- Peripheral blood smear revealed atypical lymphoid cells with Auer rod-like cytoplasmic inclusions.
- Flow cytometry identified a mature monoclonal B cell population without myeloid differentiation.
- Bone marrow biopsy confirmed the diagnosis of marginal zone lymphoma.
Conclusions:
- Marginal zone lymphoma can present with atypical cytoplasmic inclusions resembling Auer rods.
- Relying solely on morphologic features can lead to diagnostic errors.
- Integrated diagnostic approaches including flow cytometry and bone marrow biopsy are essential for accurate hematologic diagnoses.
