Page 160 - Haematologica Atlas of Hematologic Cytology

AB
CD
EF
Figure 7 Lymphoplasmacy c c c leu leu emia emia An old man had weakness and and sensory altera ons of the legs Examina on on showed pallor hepatomegaly and and and and splenomegaly Laboratory ndings revealed anemia (Hb 8 3 3 g/dL) leukocytosis (WBC 42 3x109/L) normal normal platelet count serum IgM paraprotein (60 g/L) and and and and Bence Jones proteinuria (A and and and and B) Peripheral blood smear shows lymphoid cells cells and and and increased rouleaux forma on on on Lymphoid cells cells are are larger than normal normal lymphocytes have an an an an an an ec- centric round or or or or oval nucleus some mes apparently adhering to to to to the cell cell cell cell membrane homogeneous condensed chroma n n n n n n n n n n n n n n n n n n n n abundant blue cytoplasm cytoplasm with with with regular outlines There are are are also plasmacytoid cells cells with with with more basophilic cytoplasm cytoplasm and and a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a pa- ler-staining area adjacent to to to to the nucleus (C and and and and D) Higher magni ca ca on shows cells cells cells cells with with with morphological features features intermediate between mature mature lymphocytes and and and and plasma plasma cells cells cells cells cells In a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a few cells cells cells cells cells more immature features features are are present as as as open chroma n n n n n n n n n n n n n n n n n n n n n n and and and and nucleoli (E and and and and F) Bone marrow smear with with with small in in in ltra on on on by cells cells cells cells cells with with with plasma plasma cell cell cell cell cell cell cell di di eren a a a a a a a a a a a a a a a a a a a a a a a a a a on on on Leukemic cells cells cells cells cells had a a a a a a a a a a a a a a a a a a a a a a a a a a ma- ture B-cell phenotype: surface Ig ( ( ( ) ) ) were were expressed with with with medium-high density and and in in in in in some cells cells cells chains were were also found in in in in in the cytoplasm A diagnosis of of of of Waldenström macroglobulinemia was was made The karyotype was was abnormal (48 XY +3 +12) and molecular analysis showed muta muta on of of of of MYD88 gene which is is is mutated in in in 90% of of of of cases of of of of lymphoplasmacy c c c c c c c lymphoma 147