Objectives. The present study was conducted to categorise the morphological features on bone marrow aspirate cytology into common, uncommon, and atypical features in a nonendemic region which would be helpful in clinching an early and correct diagnosis especially in clinically unsuspected cases. Methods. The morphological features on bone marrow were categorized into common, uncommon, and atypical in cases of leishmaniasis from non endemic region. Results. Out of total 27 cases, 77.7% were residents of places at the height of 500？m or above and fever was the most common presentation followed by hepatosplenomegaly. Plasmacytosis, hemophagocytosis were the common cytological features while dysmyelopoiesis, presence of leishmania bodies in nonhistiocytic cells, and granuloma with necrosis were uncommon features. Aggregates of LD bodies in form of ring, floret, or strap shapes along with giant cells constitute the atypical morphological features. Conclusion. The knowledge of common, uncommon, and atypical features on bone marrow aspirate cytology is helpful in clinching an early and correct diagnosis of leishmaniasis especially in non endemic areas where clinical suspicion is low. These features will guide the pathologist for vigilant search of LD bodies in the marrow for definite diagnosis and thus will also be helpful in preventing unnecessary workups. 1. Introduction Visceral leishmaniasis (VL) is vector borne parasitic disease which results from the infection of macrophages in reticuloendothelial system associated with immunoinflammatory response [1]. The higher altitudes negatively affect the distribution of vector, and therefore leishmaniasis is considered to be almost absent in highlands [2]. However, cases demonstrating Leishmania donovani (LD) bodies on bone marrow aspirate cytology have been observed in our tertiary care center which caters to nonendemic hilly and subhilly regions. Although bone marrow findings in VL have been described in the literature, studies have rarely categorized these morphological features into common, uncommon, and atypical features according to their frequency and presentation [3–5]. Therefore the present study was conducted to evaluate the clinicohematological profile and study the morphological features on bone marrow examination in cases demonstrating LD bodies in marrow aspirate along with the categorization of these morphological features into common, uncommon, and atypical features. It was also intended to study whether these common, uncommon, and atypical morphological features observed in bone marrow in this
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