Mudassira, Anwarul Haque.
An unusual case of diffuse small blue cell tumor of liver.
Int J Pathol Jan ;3(1):46-7.

A 10 month old boy presented with low grade fever, intermittent episodes of loose stools and progressive abdominal distention since birth. He had normal vitals except for temperature of 99°F. Physical examination revealed hepatosplenomegally. Routine laboratory tests revealed WBC 15.0 x 103/ ul, Hb 8.6g/ dl, HCT 30%, MCV 59fl, MCH 17 pg, MCHC 28 g/ dl, Platelets 233 x 103 /ul. Peripheral blood film revealed microcytic hypochromic anemia and leukoerythroblastic picture. Blood chemistry revealed alkaline phosphate 512U/L (range 85-365U/L), ALT 137 U/L (range 9-39U/ L), Albumin 4.3 g/ dl, and triglycerides 435 mg/ dl (range 59-200 mg/ d1). Serum a-fetoprotein was 7.2 ng/ml. The FNAC of enlarged liver was obtained from three different sites and smears were prepared and fixed in 95% alcohol. Bone marrow aspiration revealed hypercellular smear composed of cords and sheets of atypical round blue cells. These cells had large hyper chromatic nuclei with high N/C ratio. Some cells had cleaved nuclei giving the evidence of extramedullary hematopoiesis. A few cells having foamy cytoplasm with vacuolated appearance were also seen. A few normal hepatocytes were alsc present. No rosette formation was present. Bone marrow aspirate showed hyperplasitic of erythroid elements with mild megaloblastic change. Megekaryocytes were increased in number with left shift of maturation. A few cells resembling Neiman Pick cells having foamy cytoplasm containing clear vacuoles were seen. These vacuoles were PAS and Sudan black positive. Phagocytic activity was evident by the presence of intracytoplasmic phagocytosed nuclei.

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