Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 891
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size

IMAGE Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 2  |  Page : 370-371
Hemophagocytosis by leukemic cells in biphenotypic acute leukaemia: A rare case

1 Department of Pathology, TNMC & BYL Nair Ch. Hospital, Mumbai, India
2 Department of Pathology, Tata Memorial Hospital, Mumbai, India

Click here for correspondence address and email

Date of Web Publication12-Jun-2010

How to cite this article:
Gupta A, Modi CJ, Gujral S. Hemophagocytosis by leukemic cells in biphenotypic acute leukaemia: A rare case. Indian J Pathol Microbiol 2010;53:370-1

How to cite this URL:
Gupta A, Modi CJ, Gujral S. Hemophagocytosis by leukemic cells in biphenotypic acute leukaemia: A rare case. Indian J Pathol Microbiol [serial online] 2010 [cited 2022 May 17];53:370-1. Available from: https://www.ijpmonline.org/text.asp?2010/53/2/370/64282

   Case History Top

A male child of 6 years of age, born of non-consanguineous marriage, elder of the two siblings, presented with intermittent fever on and off of moderate grade, progressive increase in pallor of 2 months duration along with reduced appetite, decreased dietary intake and failure to gain weight. On examination, pulse was 140/min and respiratory rate was 40/min. There were herpetic lesions over the left side of lip and there was no evidence of purpura. Anthropometry revealed height, weight and head circumference of <5 th percentile. Liver was enlarged 3 cm below the costal margin. During his hospital stay he had few spikes of fever. Bone marrow aspiration was done, which was hypercellular with suppression of normal hematopoiesis, 70% blasts and numerous cells showing hemophagocytosis. The nuclei of these cells were round to oval with fine chromatin, occasional nucleolus and showed moulding due to phagocytosed cells [Figure 1]: Leukemic cell of BAL with engulfed RBC (Wright's stain; x1000) ). The cytoplasm of these cells was scant, occasional cells showing more than one phagocytosed-formed elements of blood [Figure 2]: A leukemic cell with two engulfed RBCs (Wright's stain; x1000). However, phenotyping of the phagocytosing cells was not available. Background of proliferating histiocytes was not seen. A diagnosis of acute leukemia was made Myeloperoxidase was negative on cytochemistry.[Table 1]


Acute leukemia - Myeloperoxidase negative.

   Discussion Top

Presence of cytopenia (Hb 8 gm%, total count 3800/mm 3 and platelets 1 13 000/mm 3 ) in a 6-year-old child showing failure to thrive with bone marrow showing presence of hemophagocytic cells calls for a review of literature for hemophagocytic syndromes. Reactive hemophagocytic syndromes are most commonly seen in association with infections. [1] Two histiocytes demonstrating phagocytosis of erythrocytes, lymphocytes, neutrophils, platelets or nuclear debris should be present in each slide for certainty of diagnosis. [2] This phagocytosis is associated with proliferation of benign histiocytes. (Benign histiocytic proliferation was not seen in the present case.)

In this present case of a 6-year-old child, the cytoplasm of cells showing phagocytosis was very scant. Also a background of mature histiocytes was not seen. Hence a diagnosis of familial hemophagocytic lymphohistiocytosis or its association in the present case was ruled out. Hemophagocytic syndromes are also seen uncommonly with hematological malignancies and are characterized by phagocytosis by benign histiocytes. [1] Hence an acute leukemia associated with hemophagocytic syndrome was ruled out. However, literature regarding phagocytosis by leukemic cells as seen in present case is scarce. Marked phagocytic activity was seen by the cells of myelomonocytic leukemia and monocytic leukemia, but phagocytic activity by lymphoblastic leukemic cells is rare. [3] Phagocytosis by leukemic cells in biphenotypic acute leukemia has not been reported in literature.

Biphenotypic acute leukemia is an uncommon disease and accounts for approximately four percent of all acute leukemias. [4],[5] Diagnosis is based on a published scoring system adopted by the European Group of immunological classification of leukemia (EGIL) and WHO. [4] The score allows four groups to be identified. The most common group of cases are those which co-express myeloid and B-lymphoid antigens. Less commonly, the blasts co-express myeloid and T-lymphoid antigens. Co-expression of T and B lymphoid markers and those of trilineage differentiation are rare. [5] The present case belongs to the first category of biphenotypic acute leukemia.

   References Top

1.Bain BJ, Clark DM, Lampert IA, Wilkins BS. Bone Marrow Pathology. 3 rd ed. London (UK): Blackwell Sciences; 2001. p. 119-20.  Back to cited text no. 1      
2.Favara BE. Hemophagocytic Lymphohistiocytosis, A Hemophagocytic syndrome. Semin Diagn Pathol 1992;9:63.  Back to cited text no. 2  [PUBMED]    
3.Lewis G. Phagocytosis in Acute Leukemia. Cancer 2006;45:1365-9.  Back to cited text no. 3      
4.Frater JL, Yaseen NR, Peterson LC, Tallman MS, Goolsby CL. Biphenotyipic acute leukaemia with co expression of CD79a and markers of Myeloid lineage. Arch Pathol Lab Med 2003;127:356-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Matutes E, Morilla R, Farahat N, Carbonell F, Swansbury J, Dyer M, et al. Definition of Acute Biphenotypic Leukemia. Hematologica 1999;82: 64-6.  Back to cited text no. 5      

Correspondence Address:
Charusmita J Modi
3- B -15, Krishna nagar, Chandawarkar road, Borivali west Mumbai - 400 092
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.64282

Rights and Permissions


  [Figure 1], [Figure 2]

  [Table 1]

This article has been cited by
1 A Case Report and Review of B-Lineage Acute Lymphoblastic Leukemias with Cannibalistic Lymphoblasts: A Unique Morphologic and Molecular Genetic Entity?
B K Bommannan, Man Updesh Singh Sachdeva, Shano Naseem, Alka Khadwal, Neelam Varma
Indian Journal of Medical and Paediatric Oncology. 2020; 41(06): 917
[Pubmed] | [DOI]
2 Hemophagocytosis by Leukemic Blasts in T Cell Acute Lymphoblastic Leukemia: An Unusual Finding
Aradhana Harrison,Dinesh Chandra,Naveen Kakkar,Sheila Das,M. Joseph John
Indian Journal of Hematology and Blood Transfusion. 2015;
[Pubmed] | [DOI]
3 Cytologic identification of erythrophagocytic neoplasms in dogs
Anne M. Barger,Melissa C. Skowronski,Amy L. MacNeill
Veterinary Clinical Pathology. 2012; 41(4): 587
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  

    Case History
    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded126    
    Comments [Add]    
    Cited by others 3    

Recommend this journal