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Marrow Histiocytosis

View larger version (155K): [in this window] [in a new window]   Figure 1. A 66-year-old female with a history of pancytopenia for the past 11 years. Her CBC showed a hemoglobin of 8 g/dl with an MCV of 106. a WBC of 4000/ul with PMNs predominant and with 1% metamyelocytes and myelocytes, and a platelet count of 57k/ul. Cytogenetic analysis performed on her marrow aspirate revealed a 46, XX karyotype. Her marrow aspirate is hypercellular with myeloid and erythroid series showing full maturation. Megakaryocytes are present and appear normal in number and morphologically. Large cells containing blue-tinted cytoplasm are noted as single cells and in groups in the upper half of this image.

View larger version (165K): [in this window] [in a new window]   Figure 2. A cluster of these large histiocytic cells are more evident in this higher magnification of the previous image. The cytoplasm of these cells contains multiple vacuoles and several appear to have ingested single mature RBCs and a nucleated RBC. Abundant erythroid precursors at all stages of maturation are present throughout the aspirate smear.

View larger version (154K): [in this window] [in a new window]   Figure 3. At a higher magnification, the RBCs noted in the histiocytes appear to be overlying the cytoplasm rather than representing hemophagocytosis. The erythroid hyperplasia is marked.

View larger version (109K): [in this window] [in a new window]   Figure 4. In this view of the aspirate, a sea blue histiocytes is present in the center of the image. No dysplastic changes are evident in either the erythroid or myeloid series.

View larger version (171K): [in this window] [in a new window]   Figure 5. An H & E stain of a marrow clot section is shown. Note the extensive benign-appearing histiocytosis that is present throughout this patient’s marrow. Scattered plasma cells and small lymphocytes can also be seen suggesting a granulomatous lesion. Histochemical stains for fungi and acid-fast organisms were negative.

View larger version (185K): [in this window] [in a new window]   Figure 6. A similar histiocyte-rich granuloma-like lesion is noted in this image of the marrow biopsy. Cytoplasmic vacuolization is marked in some of these cells. These cells were PAS and S-100 negative. Plasma cells, small lymphocytes, and eosinophils are also prominent. Dutcher body inclusions are present in some of the plasma cells.

View larger version (158K): [in this window] [in a new window]   Figure 7. A CD68 immunohistochemical stain on the marrow clot section highlights the extensive macrophage/histiocyte hyperplasia.

View larger version (178K): [in this window] [in a new window]   Figure 8. A higher magnification of the previous image further illustrates the extensive macrophage/histiocyte hyperplasia. A diagnosis of Erdheim-Chester disease, lipoid granulomas of the bones, kidneys, heart, and lungs could not be ruled out.

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazarchick, J. Search for Related Content PubMed Articles by Lazarchick, J. Related Collections Histiocytic hyperplasia/proliferation Related ASH-SAP Chapter Related Image Bank Image Sets Related ASH Education Book Articles Social Bookmarking                   What's this?