Kusum Kapila, MD, FIAC, Professor of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait

A 47 year old female of Indian origin was diagnosed to have Acute Lymphoblastic Leukemia (ALL) in September 2006 and completed Hyper CVAD [Cyclophosphamide, Methotraxate and Ara C] regimen in May 2007. During follow up she noticed a swelling (10 x10 mm) over the proximal interphalangeal joint of the right index finger in April 2010. She gave no history of trauma or pain and there was no discharge. The patient was HIV negative. FNA was performed and alcohol fixed and air dried smears examined.

 fig 1 2010 nov  fig 2 2010 nov
Fig 1 FNA Smear – Papanicolaou stain Fig 2 FNA Smear – Diff Quik stain

Your diagnosis?