Coexistence of leukemic infiltration and extramedullary hematopoeisis in a lymph node: A cytological diagnosis

Area of Science:

• Hematology
• Cytopathology

Background:

• Extramedullary hematopoiesis (EMH) is the formation of blood cells outside the bone marrow.
• It typically occurs secondary to bone marrow failure or destruction.
• Lymph nodes are an uncommon site for EMH.

Observation:

• A young patient presented with a lymph nodal mass.
• Fine needle aspiration cytology (FNAC) was performed on an axillary lymph node.
• Smears revealed lymphoblasts with characteristic hand mirror cell and teat cell morphologies.

Findings:

• The FNAC diagnosis indicated infiltration by leukemia.
• Features consistent with extramedullary hematopoiesis were also observed.
• Occasional megakaryocytes and metamyelocytes were identified, supporting EMH.

Implications:

• This case highlights an unusual presentation of leukemia with EMH in lymph nodes.
• FNAC is a valuable tool for diagnosing such complex hematological conditions.
• Understanding EMH in nodal leukemia is crucial for accurate diagnosis and treatment planning.