PMC4532050_01
Peripheral blood morphology with Wright-Giemsa stain shows moderate leukocytosis with increased monocytes.. Bone marrow smear shows increased myeloblasts (18%) and marked dysgranulopoietic features such as hypogranulation and pseudo-Pelger-Huet anomaly.
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Laboratory findings on admission showed that the white blood cell count was 28,000/mm3 with 2 percent blasts and 12 percent monocytes, the hemoglobin was 9.4gm/dL, the hematocrit was 28.6% and the platelet count was 21,000/mm3 (Fig. 1a). The cellularity of bone marrow was 90 percent with 17 percent blasts (Fig. 1b).
Cerebro-spinal fluid cytology reveals a few monocytoid cells.
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Cell morphologies were polymorphic and atypical monocytes and immature cells were seen (Fig. 2).
MRI brain scan after occurrence of diplopia on lateral gaze shows nodular hyperintense lesion in posterior aspect of mid-brain on contrast enhanced T1-WI.. MRI brain scan after brain radiotherapy with 2520 cGY shows nearly complete resolution of previously noted nodular hyperintense lesion in mid-brain.. CT scan of brain after development of left-sided hemiplegia reveals relatively well defined, round inhomogeneous enhanced hyperdense mass lesion with surrounding edema in right parietal region.
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Magnetic resonance imaging (MRI) brain scan revealed small nodular density in the mid-brain (Fig. 3a). After radiotherapy, a follow-up magnetic resonance imaging brain scan revealed the disappearance of the lesion (Fig. 3b). Computed tomographic scan of the brain revealed 3x4cm sized, round, hyperdense masses with surrounding edema in the parenchyma of the brain (Fig. 3c).