“Faggot Neutrophils!” in Non-acute Promyelocytic Leukemia: A Rare Occurrence

Excerpt

A 19 year old male presented with fever of 4 days duration without organomegaly or lymphadenopathy. Peripheral blood evaluation revealed anemia, thrombocytopenia and leucocytosis. Peripheral smear and bone-marrow aspirate showed > 20% blasts, many containing single Auer rod. Maturing myeloid, few neutrophils including few dysmorphic forms also showed single Auer rod. “Faggot” like multiple Auer rod collections were noted in the neutrophils (Fig. 1a, b). A diagnosis of acute myeloid leukemia (AML) with aberrant expression of CD19 and CD56 was rendered by flowcytometry. Cytogenetic studies showed the presence of t(8;21) and the karyotype was reported as 45,X,-Y,t(8;21)(q22;q22)[13]/46,idem,+8[07] as per the ISCN 2013 (Fig. 1C). Fluorescence in situ hybridization for PML-RARα was negative (Fig. 1D). The patient was started on cytarabine–daunorubicin based chemotherapy and is under follow up.

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