Blood Res 2021; 56(3): 127-127  https://doi.org/10.5045/br.2021.2021051
Plasma cells in disguise: the masquerader in hematopathology
Richa Juneja1, Karthika Kundil Veetil2, Haraprasad Pati2
1Department of Pathology, All India Institute of Medical Science, Nagpur, 2Department of Hematology, All India Institute of Medical Science, New Delhi, India
Correspondence to: Richa Juneja, D.M., Department of Pathology, All India Institute of Medical Science, 309, Near VMV College, Wardhman Nagar, Nagpur 440008, India, E-mail: drrichajuneja@gmail.com
Received: March 4, 2021; Revised: April 5, 2021; Accepted: July 8, 2021; Published online: August 5, 2021.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Six challenging morphological variants of plasma cells were identified in various plasma cell neoplasm and confirmed with flow cytometric immunophenotyping or immunohistochemistry. (A) Multinucleated plasma cells, with few resembling a megakaryocyte, in Jenner–Giemsa-stained bone marrow aspirate in an “anaplastic variant” of myeloma (×40). Inset shows a bizarre plasma cell (×100). Classical binucleate plasma cell with thick rod-like inclusion in a smear (B, ×100). A case of MGUS with intracytoplasmic coarse azurophilic Snapper–Schneid granules in plasma cells (C, ×100). In a case with a dry tap, bone marrow biopsy specimen shows large plasma cells with moderate cytoplasm, irregular nuclei with chromatin remodeling and prominent nucleoli (arrow) in a dense fibrotic marrow. Positive staining for CD138 and kappa restriction confirmed a diagnosis of plasmablastic myeloma (D, ×40). Bone marrow biopsy revealed sheet-like arrangement of small cells with scanty cytoplasm that mimic a lymphoma in a “small cell variant” (E, ×20); inset shows CD138-positive staining of all cells with aberrant CD20 positivity and CD45 negativity; FISH showed t(11:14). Bone marrow biopsy specimen showed a histiocytic variant of large plasma cells with abundant pale cytoplasm among classical small lymphoid cells in lymphoplasmacytic lymphoma (×20); inset shows CD138 positivity and lambda restriction (F).



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