A case of monocytic leukemia with marked proliferation of giant cells is reported and
discussed about their morphological details
She admitted to Seoul National University Hospital on Oct, 11, 1968. with general
malaise and pallor which had begun 40 days before.
Abnormal findings in physical examination were hepatomegaly (2FB) and ill defined
nodular mass on epigastrium.
Her hemogram on admission revealed severe anemia (Hct. : 18%, Hb. : 5.8 gm/dl),
leukopenia (900/mmg), relative lymphocytosis (78%) and immature monocytes (8%),
Morphology of immature monocytes fulfilled the criteria for the diagnosis of monocytic
leukemia of Schilling type. They have rather scanty pale blue cytoplasm with
pseudopods and vacuoles, larger nuclei containing distinct single or multiple nucleoli and
somewhat coarse chromatin patterns. Some of them looked like blast forms.
In the bone marrow examination, 81% of nucleated cells were monocytic series. There
were blast forms (60%), immature monocytes (16%), and giant cells (6%). These cells
were similar to the monocytic cells found in peripheral blood in characters, except
marked variability in size and shape. Those cells, designated as giant cells, have single
or multiple nuclei with deeply basophilic, granular and/or mottled cytoplasms with many
vacuoles and frequent phagocytic activity. Their nuclei contain usually 3 to 5 nucleoli
and rather coares chromatin. Giant cells were easily distinguished from osteoblast,
ostesoclast or atypical megakaryocyte by their characters. Though it was very difficult
to distinguish them from the Reed-Stenberg giant cells and the atypical cells of
reticulum cell sarcoma in morphology, the clinical course and hematological pictures are
rather typical for monocytic leukemia than the lymphoma.
During the 234days of hospitalization, peripheral blood pictures showed marked
increase of immature monocytes, up to 79% (Table 2). She was treated with
prednisolone for 23 days without improvements and was discharged.
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