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September 22, 1975

Acute Lymphoblastic Leukemia And Histiocytic Medullary Reticulocytosis-Reply

Author Affiliations

Veterans Administration Hospital Pittsburgh

JAMA. 1975;233(12):1258-1259. doi:10.1001/jama.1975.03260120020007

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In Reply.—  Dr Simmons may be quite right that the mediastinal mass may have been of thymic origin and that this was also the source of the abnormal cells. I do not know of any way to investigate this possibility.The illustrations of thymus from a pregnant guinea pig purporting to show eosinophilic globules are unconvincing. Dr Simmon's argument that globules rather than red blood cells were seen might be more persuasive if illustrations of human leukemic cells had been provided. I have never observed such globules in leukemic cells that could be mistaken for erythrocytes. Furthermore, the illustrations in the original report were of malignant histiocytes in the bone marrow and lymph node, not in the spleen. Although overlying red blood cells might be confused with erythrophagocytosis in the bone marrow, the normal absence of red blood cells in lymph nodes would make this error very unlikely.The presence