Anamnesis: We report the case of a 75-year-old woman with a personal history of type 2 dependent diabetes mellitus, hypertension, ischemic heart disease, skin haematoma, insulin resistance and multiple cholecystectomy, presenting multiple asthenia at 1 month
a Physical examination revealed intense mucocutaneous adenoidity, multiple cutaneous hematomas, decreased vesicular murmur, generalized with crackles in the right lung base, enlargement of the lungs, and confusion.
Complementary tests: Complementary tests yielded the following results:
-Hemogram: a) red series: hemoglobin 7.2 g/dl, hematocrit 22%, erythrocyte distribution 11.710.000/μl, MCV 81rie, platelets/500, white blood cell count 12.8μl.
Peripheral blood smear: a) red blood cell series: a congenital syphilis: 14% normoblasts, dacryocytes and some macrovalocytes; b) platelet series: 30% giant platelets; c)
-SGA: 32 mm/hour.
-Biochemistry: glucose 67 mg/dl, urea 33 mg/dl, creatinine 0.4 mg/dl, urate 5.6 mg/dl, bilirubin 1.1 mg/dl, AST 141 IU/l, ALT 38 IU/dl
-Proteinogram: albumin 54.6%, alpha 1 globulin 3%, alpha 2 globulin 11.8%, beta globulin 15.4%, gamma globulin 15.2%.
-Radiography of the chest: right basal pulmonary infiltrate.
-Abdominal ultrasound: multiple focal liver lesions with diffuse involvement of the liver parenchyma with normal liver size, marked stenosis enlarged, without visualizing intra-abdominal adenopathies.
Diagnosis: Thus, in the presence of a constitutional syndrome, fever, pancit with data on peripheral bone marrow biopsy, myelooptisis (leukaryotic reaction), and aspiration of blood in the hepatic smear were performed.
However, before obtaining the definitive result of the bone marrow examination, the patient, despite hemotherapy support, died unfavorably 9 days after admission.
Autopsy was not performed because of the family's expressed wishes.
Bone marrow examination showed the following data:
-Bone marrow aspirate: dry aspirate (myelofibrosis suggestive).
-Bone marrow biopsy: a hypercellular medullary parenchyma (5/5), a non-massive and diffuse sclerotic bone cells, with hematopoietic necrosis.
Tumor cells are large in size, abundant eosinophilic cytoplasm and vesicular nuclei, polyposis prominent with mitoses.
No hemophagocytosis phenomena were observed.
Immunohistochemistry:
•CD45/ EMA/ LISOZIMA (Golgi pattern)/ CD68: positive.
•CD79a/ CD10/ CD23/ CD43/ IgS/ CD15/ CD30/ CD45RO/ CD1a/ CD2/ CD3/ CD4/ CD8/ CD57/CDOR 34/MPX
• Cell proliferation rate (Ki 67) >80%.
Tumor cells are accompanied by T-cell lymphoid reactive cells (CD45RO/ CD2/CD3/CD8/CD57 positive) and histiocytes (CD68 positive).
The definitive diagnosis of bone marrow examination was compatible with histiocytic sarcoma according to the World Health Organization classification.
