title: Extramedullary hematopoiesis in a sentinel lymph node as an early sign of chronic myelomonocytic leukemia.
abstract: Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy with features of both a myeloproliferative neoplasm and a myelodysplastic syndrome. Even though extramedullary leukemic infiltration is common in CMML patients, lymph node involvement has rarely been reported in the literature. We present an unusual case of a 72-year-old female who was found to have extramedullary hematopoiesis (EMH) in a sentinel lymph node that was excised during mastectomy for lobular breast carcinoma. One year later bone marrow biopsy was performed due to persistent anemia, thrombocytopenia, and monocytosis and the patient was diagnosed with CMML. Our case illustrates the importance of recognizing EMH in a lymph node during routine histological examination, especially in adults. Proliferation of bone marrow elements in a lymph node, in a patient with no known hematologic disorder, should trigger immediate bone marrow evaluation, as this could be the first clue in diagnosing underlying bone marrow disorder.
authors.affiliation: Physicians Laboratory, 4840 F Street, Omaha, NE 68117, USA.
authors.forename: Joslin M
authors.initials: JM
authors.lastname: Bowen
authors.affiliation: Department of Pathology, University of Manitoba, MS559S Thorlakson Building, 820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
authors.forename: Anamarija M
authors.initials: AM
authors.lastname: Perry
authors.affiliation: Department of Pathology and Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Quist
authors.affiliation: Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California (USC) and Norris Cancer Center, USC University Hospital, 1441 Eastlake Avenue, Norris Topping Tower 3463, MC 9172, Los Angeles, CA 90033-9172, USA.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Akhtari