Page 167 - Haematologica Atlas of Hematologic Cytology

CHAPTER 17 - - Mature B-cell neoplasms
Figure 19 Plasma cell cell myeloma with multilobated plasma cell cell nuclei A 72-year-old asymptomatic man pre- sented with a a a a a a serum monoclonal gammopathy (IgG ) He was slightly anemic There were no no lytic lesions of the skeleton (A) Bone marrow smear reveals high cellularity and and a a a a a a a a a massive infiltration of cells with convoluted and and multilobated nuclei These cells are large with abundant basophilic cytoplasm and bizarre nuclear morphology: nuclei are sometimes sometimes irregular or or deeply indented with monocytoid features sometimes sometimes bilobed or or multilobed with with prominent blebs Chromatin is is rather dense with with few visible nucleoli Occasional cells have typical plasma cell cell morphology (B) Immunofluorescence for light chain shows that most cells are labeled by anti- PCM with convoluted and and multilobated nuclei is a a a a a a a a a a a a rare morphological variant characterized by an an an an aggressive course and and resistance to to to conventional chemotherapy The unusual cytological features often make it difficult to to to recognize Immunocytology may be useful to to to avoid a a a a a a a a a a mistaken diagnosis of other hematologic malignancies in particular monocytic leukemia AB Figure 20 Plasma cell myeloma with with erythrophagocytosis A A 52-year-old patient presented with with chest pain A A diagnosis of multiple myeloma g g with costal and and vertebral localizations was made and and the patient has been successfully treated Three years later he presented persistent severe anemia with a a a a a a a a high transfusion need and thrombocytopenia (A) Bone marrow smear shows massive infiltration by plasma plasma cells A A plasma plasma cell cell demonstra- tes phagocytosis of of a a a a a a a a a a mature erythrocyte (B) Phagocytosis of of a a a a a a a a a a red cell cell by a a a a a a a a a a binucleated plasma cell cell Hemopha- gocytosis by myeloma cells is is a a a a a rare but well recognized phenomenon that may be responsible for the hemolytic anemia observed in cases of PCM 154