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Duke University Medical Center
02/19/2003

Bands 8 (6-36) Atypicals 0   RBC Precursors 19 (10-30)
Metas 6 (9-25) Lymphoblasts 0   Pronormoblasts 0 (0-3)
Myelos 9 (8-15) Eosinophils 3 (0-4) M:E Ratio 2/1  
Promyelos 2 (1-6) Basophils 0 (0-1) Iron 0 (0-4+)
Myeloblasts 0 (0-3.5) Monocytes 1 (0-2)      

MICROSCOPIC EXAMINATION:

Peripheral blood: The CBC: Hgb-12.7, WBC-6.7, platelets-439, MCV-95, and RDW-13.2. The cytomorphology of red and white blood cells are within normal limits. No Rouleaux formations are seen. Circulating plasma cells are not identified. Platelets are adequate in number and morphology.

Bone marrow aspirate: Particles are moderately cellular. There are numerous atypical plasma cells with large nuclei, prominant pink nucleoli and abundant bubbly cytoplasm. They comprise more than 60% of the cellularity. The rest of cellularity demonstrates maturing trilineage hematopoietic precursors in varying stages of maturation. Excess blasts or dysplastic changes are not identified.

Bone marrow touch preparation shows similar findings.

Prussian blue stained aspirate smear reveals absent iron storage. Ringed sideroblast are not identified.

Bone marrow core biopsy: The overall cellularity is 60% of which two thirds are plasma cells. They appear as sheets and individuals infiltrating interstitially. There are scanty amount of trilineage hematopoietic precursors in maturation. Megakaryocytes are adequate in number.

Reticulin stain shows slight diffuse reticulin fibrosis.

FLOW CYTOMETRY FINDINGS:

SAMPLE COMPOSITION

67% Myeloid 10% Lymphoid 2% CD19
4% Monocytic 7% CD3 1% kappa
4% Erythroid 4% CD4 1% lambda
  1% CD8  

Antibodies (antigens) tested: CD71, CD33, CD45, CD5, CD22, CD3, Kappa, Lambda, CD19, CD4, CD, CD38, CD56 and CD138.

INTERPRETATION: Present is a phenotypically abnormal population exhibiting forward and right-angle scatter features of large cells and low CD45 expression, which constitutes 3% of analyzed events. It expresses bright surface CD38 and CD138. It is weakly positive for CD56. It is negative for surface expression of CD19, CD20 and CD22. This low proportion of plasma cells is not accurate when compared to bone marrow morphology, and is likely due to poor in-vitro survival of plasma cells. Please see microscopic description.

DIAGNOSIS:
A, B, F. "PERIPHERAL BLOOD, BONE MARROW" (PERIPHERAL BLOOD, ASPIRATE SMEAR, TOUCH PREPARATION, CORE BIOPSY, FLOW CYTOMETRY IMMUNOPHENOTYPING):

PLASMA CELL MYELOMA (>60%)
ABSENT IRON STORAGE

Cytogenetics: No clonal abnormalities

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