Palmer, Ellen B-6913
Specimen: Bone marrow aspirate ( 164807)
Clinical History/Indications: A 58 year old female with a clinical history of multiple myeloma, prior chemotherapy, elevated IgA, and pancytopenia, rule out progression of myeloma and myelodysplasia.
Flow Cytometric SSC/CD45 Differential: 26% lymphocytes, 10% monocytes, 17% myeloid forms, 0.2% lymphoblasts, 1.9% myeloblasts, and 28% cells demonstrating the phenotypic and scatter characteristics consistent with plasma cells.
Immunophenotypic Findings: Independent immunophenotypic analysis was performed based on CD38 intensity. The plasma cells are negative for CD56 with negative CD45 expression and express cytoplasmic lambda immunoglobulin light chain. In addition, a subpopulation of abnormal plasma cells express CD19, and the majority of plasma cells are CD33 positive. The cells lack expression of TdT, myeloperoxidase, and all other lymphoid and myeloid cells tested. Analysis of the maturing myeloid cells reveals no evidence of abnormal myeloid antigen expression or increased myeloblasts. Total non-erythroid cells expressing CD34 are present at 0.2%.
Analysis/Conclusions: The above findings reveal the presence of monoclonal lambda plasmacytoid cells in the bone marrow at 28%, a decreased myelopoiesis (see comment).
Comment : The presence of CD33 expression on the abnormal plasma cells indicates a markedly aberrant phenotype, most consistent with an anaplastic plasma cell population, and most likely accounts for the decreased myeloid elements.
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