Abstract

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 23 days 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.