|IMAGE IN HEMATOLOGY
|Year : 2018 | Volume
| Issue : 1 | Page : 37-38
Plasma cell leukemia with a multiple auer rod-like
Department of Pathology and Laboratory Medicine, Hematology Unit, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Web Publication||22-Mar-2018|
Dr. Adnan Alkhayat
Department of Pathology and Laboratory Medicine, Hematology Unit, King Saud University Medical City, College of Medicine, King Saud University, P. O. Box: 89885, Riyadh 11692
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Alkhayat A. Plasma cell leukemia with a multiple auer rod-like. J Appl Hematol 2018;9:37-8
A 64-year-old female, a known case of diabetes mellitus, hypertension, dyslipidemia, vertebral fracture, and asthma, presented in emergency room with palpitation. Laboratory studies were remarkable for anemia (hemoglobin, 77 g/L), thrombocytopenia (platelets, 112 × 109/L), and normal white blood cell (WBC) count (WBC 7.4 × 109/L). Peripheral blood smear shows many abnormal cells (32% of all WBCs) with multiple Auer rod-like inclusions of cytoplasm presented in clusters but the overall features, morphologically, in favor of plasma cells [[Figure 1], panel a-d]. Serum protein electrophoresis shows monoclonal gamma globulin (37.34 g/L). Kappa free light chain (FLC) 4660 mg/L, lambda FLC 46.3 mg/L, K/L ratio 100.65, creatinine 167 mmol/L, and calcium 2.62 mmol/L. Initial flow cytometric studies, which were done on peripheral blood and bone marrow aspirate, revealed monoclonal plasma cells expressing CD38, CD138, CD56, and kappa light chain and negative for CD19, CD20, and lambda light chain. In addition, plasma cells were highlighted by CD138, kappa light chain restriction [[Figure 1], panel e], and CD56 [[Figure 1], panel f] by immunohistochemistry. Cytogenetic study was done by fluorescence in situ hybridization and revealed a negative results for 17p13.1 (TP53), 13q14.3 deletions (D13S319), t (11; 14) (IGH/CCND1), t (4; 14) (IGH/FGFR3), and t (14; 16) (IGH/MAF) gene rearrangement.
|Figure 1: (a-c) The peripheral blood film showing many plasma cells with an unusual cytoplasmic inclusion, mainly in the form of an Auer rod-like. (d) The peripheral blood revealing few medium-sized plasma cell aggregations. (e) The bone marrow biopsy stained by kappa IHC. (f) The bone marrow biopsy stained by CD56 (A courtesy and acknowledgment to Dr. Alia Al-Fraedi, a consultant hematopathologist at KSUMC, for her contribution)|
Click here to view
Plasma cell leukemia diagnosed when clonal plasma cells >20% of total leukocytes in the blood or the absolute count is >2 × 109/L. Few cases have been reported of the presence of Auer rod-like inclusion in plasma cell neoplasm. These cases could be mistaken with acute myeloid leukemia, and thus, immunophenotyping is essential to differentiate in such cases.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.