A 60-year-old man was hospitalized for weakness, back pain, and respiratory distress. Multiple lymph nodes, liver, and spleen enlargements were palpable. Blood cell count findings were hemoglobin 9.4 g/dL, white blood cells 7.910 × 109/L, and platelets 6 × 109/L. Peripheral blood film observation revealed leuco-erythroblastosis. A bone marrow aspiration yielded a viscous mixture with brownish clumps (see figure panel A) leading to dark smears (panel B). The marrow was heavily infiltrated by noncohesive tumor cells, and the cytoplasm contained heterogeneous dark brown granules (panel D). Numerous background macrophages also showed cytoplasmic pigmentation (melanophages, panel E). Bone marrow biopsy immunochemistry was positive for Melan A. A dorsal melanoma was found, as well as widespread vertebral, liver, and spleen metastases (panel C). Despite intensive care the patient died.
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