<unk>  can be detected on a routine blood smear examination or manual differential. If the number of suspicious cells is low, a smear can be prepared from the buffy coat of the blood sample to concentrate the cells. Tumour cells in peripheral blood may look similar to circulating blasts or lymphoma cells. Features that aid in distinguishing tumour cells from other cells include their very large size, mature nuclear chromatin pattern, vacuolated cytoplasm, and their tendency to appear in clumps or clusters, although some of these characteristics are shared by megakaryoblasts and monoblasts. Tumour cells are often found at the edge of the blood smear due to their large size, so this area should be examined thoroughly if<unk>  is suspected. Cytochemical staining and immunohistochemistry techniques can help determine the lineage of the cells. When immunophenotyped by flow cytometry, the cells are generally CD45 negative and may express CD56, a profile that is non-specific but unusual for hematologic malignancies. In some cases, flow cytometry and FISH results may be misleading, as circulating tumour cells can exhibit cell markers and chromosomal abnormalities associated with hematologic diseases. Bone marrow examination is indicated in<unk>  to better characterize the tumour cells. Differential diagnosis<unk>  must be distinguished from the following conditions: * Acute leukemia * Circulating immature cells secondary to chemotherapy * Circulating endothelial cells, megakaryocytes or osteoclasts * Leukemoid reaction * Lymphoma
Carcinocythemia
Tachyphylaxis
Granulocytosis
Acariasis
Enterotoxemia
Thrombocythemia
Calciphylaxis
Myiasis