A 14-year-old child presented with generalized lymphadenopathy and massive hepatosplenomegaly. Peripheral smear and bone marrow examination were suggestive of Ph' positive chronic myeloid leukemia (CML) in chronic phase. However, lymph node biopsy showed extramedullary blast crisis with evidence of myeloid and T cell markers in blasts. Reverse transcriptase-polymerase chain reaction from lymph node aspirate revealed transcript for bcr-abl p210. Thus, we present here a unique case of childhood CML with extramedullary biphenotypic blast crisis (myeloid/T cell type) at initial presentation with bone marrow remaining in chronic phase. This case provides further evidence to the highly heterogeneous presentation of CML.

Acute basophilic leukemia (ABL) is a rare form of leukemia. The diagnostic criteria have recently been described. Morphological evidence for basophilic lineage is required for its classification. However the criteria for remission status and standard therapy is not established. Here we have described an atypical case of ABL and reviewed the literature to high light issues regarding diagnosis and management, which need further discussion.

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