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Postmortem examination revealed extensive extramedullary leukaemic infiltration in the liver, heart, brain parenchyma and meninges, confirming widespread disease beyond the commonly recognised medullary involvement. This case highlights the diagnostic challenges in differentiating extramedullary APL from haemorrhagic complications and differentiation syndrome. Our literature review reveals that extramedullary involvement in APL at diagnosis is rare but clinically significant, with skeletal and central nervous system (CNS) being the most common sites. The optimal management strategies remain undefined, particularly for CNS-directed therapy. This case underscores the importance of considering extramedullary involvement in APL patients with atypical or rapidly progressive presentations.<\/jats:p>","DOI":"10.1136\/bcr-2025-265666","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:35:22Z","timestamp":1774532122000},"page":"e265666","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Extramedullary manifestations of acute promyelocytic leukaemia at initial diagnosis: an autopsy analysis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5383-2589","authenticated-orcid":false,"given":"Lekshmon","family":"K S","sequence":"first","affiliation":[{"name":"Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aravind","family":"Sekar","sequence":"additional","affiliation":[{"name":"Histopathology, PGIMER, Chandigarh, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pankaj","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9495-9789","authenticated-orcid":false,"given":"Arihant","family":"Jain","sequence":"additional","affiliation":[{"name":"Clinical Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, CH, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026032606351071000_19.3.e265666.1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2008.1.391"},{"key":"2026032606351071000_19.3.e265666.2","doi-asserted-by":"crossref","DOI":"10.4084\/mjhid.2011.067","article-title":"History of acute promyelocytic leukemia: a tale of endless revolution","volume":"3","author":"Lo-Coco","year":"2011","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"2026032606351071000_19.3.e265666.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1300874"},{"key":"2026032606351071000_19.3.e265666.4","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1200\/JCO.2016.67.1982","article-title":"Improved Outcomes With Retinoic Acid and Arsenic Trioxide Compared With Retinoic Acid and Chemotherapy in Non\u2013High-Risk Acute Promyelocytic Leukemia: Final Results of the Randomized Italian-German APL0406 Trial","volume":"35","author":"Platzbecker","year":"2017","journal-title":"JCO"},{"key":"2026032606351071000_19.3.e265666.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00193-X"},{"key":"2026032606351071000_19.3.e265666.6","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12909"},{"key":"2026032606351071000_19.3.e265666.7","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-04-347229"},{"key":"2026032606351071000_19.3.e265666.8","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.0954-6820.1957.tb00124.x","article-title":"Acute Promyelocytc Leukemia","volume":"159","author":"Hillestad","year":"1957","journal-title":"Journal of Internal Medicine"},{"key":"2026032606351071000_19.3.e265666.9","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/MOH.0000000000000221","article-title":"What\u2019s new in the pathogenesis of the coagulopathy in acute promyelocytic leukemia?","volume":"23","author":"Mantha","year":"2016","journal-title":"Curr Opin Hematol"},{"key":"2026032606351071000_19.3.e265666.10","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2016.69"},{"key":"2026032606351071000_19.3.e265666.11","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.clml.2021.12.007","article-title":"FLT3-ITD Mutation Does Not Influence Survival Outcome in Adult Acute Promyelocytic Leukemia Patients Treated With ATO and ATRA-Based Therapeutic Regimen: Experience From a North Indian Tertiary Care Centre","volume":"22","author":"Deka","year":"2022","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"2026032606351071000_19.3.e265666.12","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2011.044933"},{"key":"2026032606351071000_19.3.e265666.13","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2011.049007"},{"key":"2026032606351071000_19.3.e265666.14","doi-asserted-by":"crossref","unstructured":"Picharski GL , Andrade DP , Fabro ALMR , et al . n.d. 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