PMC5308052_01
(a-c) Bone marrow aspirate showing malignant tumor cells in groups with cytoplasmic vacuoles (Jenner-Giemsa, x400). (d) Occasional syncytiotrophoblast seen (Jenner-Giemsa, x400)
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F1
Bone marrow aspiration smears showed groups and singly scattered tumor cells [Figure 1a]. These cells were highly pleomorphic, had high nuclear cytoplasmic ratio with moderate to abundant amount of vacuolated cytoplasm [Figure 1b]. Extracellular basal membrane [Figure 1c] like material was also noticed. Occasional syncytiotrophoblast [Figure 1d] was also seen.
Diffuse infiltration of the marrow spaces by tumor cells (a) (H and E, x40) and (b) (H and E, x100). (c) Tumor cells showing high N: C, vesicular chromatin, and prominent nucleoli (H and E, x200). (d) Diffuse nuclear immunopositivity taken by tumor cells (SALL-4 immunohistochemistry, x400)
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F2
Bone marrow biopsy showed diffuse infiltration of the marrow spaces by same type of tumor cell [Figure 2a and b]. These cells were having high nucleocytoplasmic ratio, vesicular chromatin, and prominent nucleoli with moderate amount of cytoplasm [Figure 2c]. Immunohistochemistry on bone marrow biopsy showed tumor cells positive for cytokeratin, PLAP and CD117, SALL4 and negative for CD30, and epithelial membrane antigen [Figure 2d].