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Electron Microscopic and Peroxidase Cytochemical Analysis of Pink Pseudo-Chediak-Higashi Granules in Acute Myelogenous Leukemia¹

Sacred Heart Medical Center, Spokane, Washington 99024 [W. A. D.]; Station 5, Pasco, Washington 99301 [R. J. K.]; and Department of Pathology, University of California School of Medicine, San Francisco, California 94143 [D. F. B.]

Giant round pink inclusions (2 µm) were seen in neutrophilic myeloblasts, promyelocytes, and myelocytes from three patients with acute myelogenous leukemia. On preliminary examination of the bone marrow smears, these inclusions looked like ingested red blood cells in that they were pink and not azurophilic. The bone marrow specimens were processed for the electron microscopic demonstration of peroxidase with 3,3'-diaminobenzidine and H₂O₂ at pH 7.6. In all three cases, the inclusions were determined to be large peroxidase-positive granules since they were limited by a single unit membrane and, unlike endocytized red blood cells, were not contained within phagocytic vacuoles. The granules were homogeneously dense for peroxidase and showed no obvious crystalline structure when examined stained or unstained on grid. We believe that they correspond to the giant pink round granules Van Slyck and Rebuck observed in immature leukemic granulocytes in 1974 and termed the pseudo-Chediak-Higashi anomaly. Like the giant purple granules seen in leukemia with this anomaly, these granules also appear to be an abnormal variant of peroxidase-positive azurophil (primary) granules. Their lack of azurophilia is due to the absence of sulfated glycoaminoglycans.

¹ This investigation was supported by Grant CA-14264 from the National Cancer Institute, Department of Health, Education and Welfare.

² To whom requests for reprints should be addressed.

Received 5/13/80. Accepted 9/12/80.

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