In the attached photos we can see some cells having similar morphology that in a 65 old years man with middle anaemia (90 g/L) were 23% of a total 5200 lymphocytes. What suggest these?
Because I know the final diagnosis, this is a further contribution to the discussion and sharing of professional experiences in haematological morphology.
Thank you for your answer, Marco
I think that the cell with some "pseudopods" may have been misleading. As you can see in the attached photos, in the HCL cytoplasmic hair are longer and thinner; in addition the nucleolus that is clearly visible in the HCL variant (HCLv) in the "classic" HCL is not evident.
The cells look very plasmacytoid. Hence, plasma cell leukaemia should be in the differential diagnosis. Will be interested to know the final diagnosis. Siva
I wonder whether this is Plasmacytoid Dendtritic Cell Neoplasm'? What was the phenotype?
Siva
Thanks for your suggestions, Siva. At case presentation, I considered both for differential diagnosis (from hairy, only the HCLv). Even the prolymphocytic leukaemia was considered but the percentage of pathologic cells below 55% ruled out this last hypothesis. So, despite a "non typical" morphology, the immunophenotyping (inter alias positive for surface IgM K restricted, FMC-7, CD 43; negative for CD5, CD 56 and CD123) as well as clinical features suggested the final diagnosis of "blastoid mantle cell lymphoma". In clinical laboratory the presence of neoplastic lymphocytes in the peripheral blood can be supposed before microscopic review by observing carefully the cytografic images provided by the hematological analysers. In most of these, the atypical lymphocytes cause a "pseudo-basophilia" with pathognomonic cytographic aspects. In the attached image an exemple from Mindray BC-6800. Similar images are provided by Sysmex XE and XN series as well as by Siemens ADVIA 2120.
This was a good discussion. I hope they will continue with these and other images
Hi Antonio,
Prolymphocytic leukaemia (PLL) is my first differential. Meanwhile, does the patient has organomegaly, especially splenomegaly?
Dear John
as I said in the answer to Siva, the percentage of pathological cells was too low for prolymphocytic leukaemia. There was splenomegaly and lymphoadenolegaly. Furthermore the first photo shows that two cells are not only very close but seem to be merged. This fact is not usual in the leukaemic cells while can be present in the solid tumors as well as in the lymphomas
Hi Gioia, this was interesting case for discussion.
And how about the CyclinD1 result? We had "blastiod mantle cell lymphoma" case with higer WBC count beford.
Yau
Hi Yau
unfortunately, cyclinD1 was not yet used in the laboratory of hospital when the patient was admitted. However as you know, MCL D1-negative have clinical and morphological features indistinguibles from MCL D1-positive. It could be interesting if you add some images of your case to this discussion
Thank you for sharing the nice pictures. Can we still diagnose this patient as Blastoid MCL with CD5 negativity on flow... Also the status of Cyclin D1 and/or BCL1 rearrangement (11,14 translocation) wasn't known...
Looking just at the morphology of blood smear these cells has very similarity with plasmacitoid cells, even if we see one cell with hairy picture it is just a citoplasmatic crush-artefact Gumprecht like image. Nucleolus is prominent like in proLy, but citoplasm is dark blue which I see often in plasma cell discrasia, or plasmacitoid cells. I would disclose that this is a lymphoproliferative neoplasm where Ly has plasmacytoid differentiation. Leukemic MCL or its blastoid manifestation is almost imposible to disclose from smears presented here.
WHO2016 has distinguished MCL which is CyclinD1 neg but SOX11+.
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