Cytologic Expressions of Spontaneous Tumor-Specific Immunity in an Untreated Myelomonocytic Leukemia

A monocytosis of about 40% had been persistently described for several months in a 49-year-old Caucasian female during examination for benign upper respiratory and gastrointestinal viral-type infections. Finally, a persistent low-grade fever, asthenia and abdominal discomfort led to the hematological diagnosis of acute myelomonocytic leukemia. The past history revealed multiple atopies. In the peripheral blood there were different kinds of lymphocytes with predominance of small, round agranular ones and moderate eosinophilia; the leukemic cells were large monocytoid elements with bizarre poly-lobulated nuclei of fine chromatin mesh, pale blue, agranular cytoplasm with many large vacuoles. The remarkable feature was that the monocytoid elements were in spherical clusters of 5–50 or more cells and that these clusters always contained a few small lymphocytes. These clusters were not broken by the smearing on the slide and because of their mass they rolled to the edges of the smear. The length of the smoldering, asymptomatic disease with ‘monocytosis’, the abundance of small lymphocytes and the clustering or rosetting of monocytoid-lymphocytic elements were taken as indications of auto