Acute Myeloid Leukemia with Hemophagocytosis: Diagnostic Cues and Potential Pitfalls.
Bibliographic record
Abstract
Hemophagocytosis is the process of phagocytosis of erythrocytes or other hematopoietic precursors by histiocytes or macrophages. Increased histiocytic activity may be observed in infections, inflammation, bone marrow hyperplasia, ineffective hematopoiesis, malignancies, as well as in hemophagocytic lymphohistiocytosis (HLH). Here we present two challenging cases of acute myeloid leukemia (AML) with associated hemophagocytosis, one in which hemophagocytosis provided a diagnostic cue and another in which extensive HLH obscured the underlying AML. The first case highlights the characteristic morphologic (leukemic blasts with erythrophagocytosis) and immunophenotypic findings (high side scatter and bright HLA-DR expression) observed in AML with t(8;16). The second case highlights the importance of careful bone marrow examination to rule out an underlying malignancy in children presenting with HLH, as the diagnosis and treatment of primary malignancy is crucial in successful management. The second case also shows an uncommon presentation of AML with concomitant EBV-associated HLH. A high index of suspicion for malignancy based on clinical history and careful bone marrow examination led us to reach the definitive diagnosis in a timely manner and allowed for optimal patient management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".