title: Unexpected Epithelial Membrane Antigen (EMA) and Cytokeratin Expression in a Case of Infantile Acute Monoblastic Leukaemia.
abstract: A previously healthy eleven month old male Malay infant presented with fever, upper respiratory tract infection and right knee swelling. Pallor, bilateral proptosis, hepatosplenomegaly, multiple scalp swellings and a right cheek swelling were observed. Investigations revealed that he had acute monoblastic leukemia or FAB M5a. Immunophenotyping by flow cytometry showed that the blast cells were positive for CD45, CD13, CD33, HLA-DR, CDllc, CD71, EMA, and Cytokeratin. They were negative for CD34, CD19, CD10, CD22, CD2, CD3, CD4, CD7, CD8, CD61, NK, Glycophorin A, and CD14. The monoblasts were used to evaluate anti-EMA and anti-cytokeratin. They were unexpectedly found to be positive. Acute monoblastic leukaemias are well known to show extramedullary infiltration and this may be their primary mode of presentation. Thus, in immunochemostry, when using EMA and cytokeratin expression in the differential diagnosis of neoplastic diseases, it is important to consider that monoblasts may express these markers as illustrated by this case.
authors.affiliation: a Haematology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia , Kuala Lumpur.
authors.forename: S K
authors.initials: SK
authors.lastname: Cheong
authors.affiliation: a Haematology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia , Kuala Lumpur.
authors.forename: S F
authors.initials: SF
authors.lastname: Chin
authors.affiliation: a Haematology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia , Kuala Lumpur.
authors.forename: O
authors.initials: O
authors.lastname: Azizon
authors.affiliation: a Haematology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia , Kuala Lumpur.
authors.forename: O
authors.initials: O
authors.lastname: Ainoon
authors.affiliation: a Haematology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia , Kuala Lumpur.
authors.forename: N H
authors.initials: NH
authors.lastname: Hamidah
keywords: EMA; acute monoblastic leukaemia; cytokeratin