#00066326

A 33-year-old male presented with febrile spikes and weight loss for a month. Complete blood count of the patient revealed persistent thrombocytopenia. Bone marrow examination was performed. The bone marrow aspirate revealed the bone marrow to be replaced by single and small clusters of pleomorphic atypical cells with increase nuclear cytoplasmic ratio and few cells revealing cytoplasmic vacuolations. Flow cytometry for leukemia and lymphoma markers was inconclusive.

On ENT evaluation the patient was found to have nasal polyps. Simultaneously done MRI brain with contrast revealed a mass like lesion in the right maxillary sinus and right nostril.The findings were suspicious for an inverted papilloma. 

The biopsy from the soft tissue mass revealed rounded tumor cells with bright eosinophilic stroma with a rhabdoid appearance showing an alveolar pattern. These cells were positive for desmin, myogenin and Myo D1. The bone marrow biopsy was replaced by atypical cells which also marked for desmin.The patient was started on chemotherapy and is on follow up.

The image on the top shows bone marrow aspirate involved by the tumor cells. The lower image the bone marrow biopsy replaced by the rhabdomyosarcoma cells.