Turk J Hematol 2006; 23:212-213 IMAGES IN HEMATOLOGY © Turkish Society of Hematology Images in hematology Naciye Demirel Yıldırım1, Nilüfer Alpay1, Reyhan Diz Küçükkaya1, Öner Doğan2 1Department of Internal Medicine, Division of Hematology, Istanbul University Faculty of Medicine, Istanbul, Turkey 2Department of Pathology, Istanbul University Faculty of Medicine, Istanbul, Turkey [email protected] Figure 1. Caseous necrosis and lymphohistiocytic granulomatous Figure 2. Erythrocyte and metamyelocyte phagocyted by histiocytes lesions are seen in the bone marrow biopsy. are shown in the bone marrow aspirate smear. Figure 3. Neutrophil and platelets phagocyted by histiocytes are Figure 4. Myelocyte and band neutrophil phagocyted by histiocytes shown in the bone marrow aspirate smear. are shown in the bone marrow aspirate smear. An eighty-seven year old man presented with hepatomegaly. There was no lymphadenopathy fever of six months duration, bone pain, fa- or splenomegaly. His body temperature was tigue and weight loss. On his physcial examina- measured as 38.2 °C. His blood picture revealed tion, he was found to be pale and to have 2 cm. a haemoglobin value of 8.4g/dl, haematocrit val- 212 ue 24 %, mean corpusculer volume of 105 fL, sis and neutrophilic toxic granulation. The bone total leucocyte count of 2900/mm³, neutrophil marrow aspirate smear showed phagocytosis of count of 1900/mm³, lymphocyte count of 800 erythroblasts, platelets and myeloid cells by his- /mm³ and platelet count of 497.000/mm³. The tiocytes. A few of the myeloid cell was showed erithrocyte sedimentation rate was 143 mm/ cytoplasmic hypergranulation. The bone marrow h. All the biochemical test results were within biopsy revealed caseous necrosis and lympho- normal range, except for elevated serum lactate histiocytic granulomatous lesions. A diagnosis dehydrogenase, alkaline phosphatase and as- of disseminated tuberculosis was made and he partate amino transferase levels. The peripheral was admitted to the hospital but he died after smear showed rouleaux formation, macrocyto- two days. Volume 23 • No 4 • December 2006 213.