Page 281 - Haematologica Atlas of Hematologic Cytology

CHAPTER 34 - Metastases of solid tumors
Figure 12 Neuroblastoma Bone marrow smear from a a a a a a a a a a 14-year-old girl presenting with fever arthralgias and mild anemia (A and B) Heavy infiltration of medium-sized cells sometimes grouped to form clusters with high nuclear:cytoplasmic ratio rather loose nuclear nuclear chromatin evident nucleoli basophilic cytoplasm cytoplasm often with irregular tails or protuberances sometimes vacuolated (C) Coarse granular positivity to the periodic acid Schiff reaction in a a a a a a a a a a a small percentage of cells cells (D) Most cells cells are positive to the alpha-naphthyl-acetate esterase re- action On the the the basis of morphological criteria these cells could be be classified as as as as lymphoblasts even because the the the alpha-naphthyl-butyrate esterase reaction specific for the monocytic lineage proved to be negative The de- tection of neurone-associated antigens such as as PGP9 5 NeuN and the the antigen antigen recognized by the the NB84 antibody helped to to establish the the correct diagnosis Neuroblastoma as as as well as as as other small round-cell solid tumors
of chil- dhood can be involved in in in in massive infiltration of the bone marrow and enter into differential diagnosis with leu- kemias and lymphoblastic lymphomas In children the diagnosis of neuroblastoma may sometimes be suggested by by the the presence of of of extracellular blue-gray fibrillary material and also by by the the finding of of of rosettes of of of tumor cells in in in the the histological sections of the the bone marrow 268