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Massive bone marrow involvement by clear cell variant of rhabdomyosarcoma with an unusual histological pattern and an unknown primary site

¹ Department of Pathology and Laboratory Medicine, Thunder Bay regional Health Science Centre, Ontario, Canada
² Divisions of Pathology and Medicine, and Division of Haematology and Oncology, Department of Paediatrics, The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Correspondence to:
Prashant Jani, MD, Department of Laboratory Medicine, Thunder Bay Regional Health Science Centre, 980, Oliver Road, Thunder Bay, Ontario, Canada P7B 6V4; janip@tbh.net

Accepted 22 August 2007

The first 150 words of the full text of this article appear below.

A previously well teenage Caucasian boy presented to the paediatric clinic with headache and myalgia. His past medical history was otherwise unremarkable. Physical examination showed petechiae over his arms and legs. Peripheral blood smear showed moderate anaemia and severe thrombocytopenia. The cerebrospinal fluid was negative. Bone scan was normal.

Examination of the bone marrow (BM) aspirate showed a diffuse infiltrate by a population of intermediate-sized mononuclear cells that existed singly or in clusters. The tumour cells had vacuolated cytoplasm, round nuclei containing multiple small nucleoli, and a high nucleus to cytoplasmic ratio. There were no cytoplasmic granules or Auer rods (fig 1A). The tumour cells were negative for routine cytochemical stains. Flow cytometry identified a population of mononuclear cells negative for leukocyte common antigen (CD45). Histological examination of the BM biopsy showed compact sheets of small round cells that packed the intertrabecular spaces. The . . . [Full text of this article]