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Acute plasmablastic leukemia – A diagnostic challenge

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1 Senior Resident Physician, Department of Pathology and Laboratory Medicine, MedStar, Georgetown University Hospital, Washington DC, USA

2 Professor, Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington DC, USA

Address correspondence to:

Dong Hyang Kwon

MD, Georgetown University Hospital, Pathology, 3900 Reservoir Rd NW Med Dent Building 2nd floor, SW 201, Washington DC,

USA

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Article ID: 100959Z01DK2018

doi: 10.5348/100959Z01DK2018CL

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How to cite this article

Kwon DH, Kallakury B. Acute plasmablastic leukemia – A diagnostic challenge. Int J Case Rep Images 2018;9:100959Z01DK2018.

ABSTRACT


No Abstract

Keywords: Myeloma, Plasmablastic Leukemia, Plasmablastic myeloma

CASE REPORT


A 58-year-old male with myeloma treated with chemotherapy and bone marrow transplant presented with thrombocytopenia and anemia. A peripheral blood smear showed numerous blast-like cells (30%), some with subtle plasmacytoid morphology (Figure 1 - Panel A). Flow cytometry analysis showed variable expression of CD38, CD56 and cytoplasmic kappa-restriction (Figure 1 - Panel B, C, D). Due to negativity for CD138, an innovative approach of cell block preparation from peripheral leukocyte pellet was attempted and demonstrated positivity for MUM1 (Figure 1 - Panel E). Following a diagnosis of plasmablastic leukemia, a bone marrow aspirate showed mostly undifferentiated blastic cells (90%) (Figure 1 - Panel F) with the same phenotype noted above (biopsy not performed). These findings confirmed plasmablastic myeloma presenting as plasmablastic leukemia. The patient expired within 6 months of above diagnosis.

Figure 1: (A) Peripheral blood smear showing blasts with plasmacytoid morphology [1000x, Giemsa stain]; (B, C, D) Flow cytometry analysis showing kappa-restricted tumor cells to be positive for CD38 and CD56, confirming plasmacytic differentiation; (E) Tumor cells show immunoreactivity to MUM1 [400x, IHC stain for MUM1]; (F) Bone marrow aspirate showing blasts with similar plasmacytoid morphology.

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DISCUSSION


Blastic cells in peripheral blood with subtle plasmacytoid morphology raise a broad differential diagnosis including acute leukemia and leukemic phase of myeloma, plasmablastic lymphoma and other non-Hodgkin’s lymphomas. Plasma cell leukemia in itself is infrequent but presentation with plasmablasts of this degree in the peripheral blood is rare. Plasmablasts can involve blood as terminal phase of myeloma [1] and this stage may deserve the designation of acute plasmablastic leukemia.

CONCLUSION


This is a rare presentation of plasmablasts in peripheral blood of a patient with multiple myeloma indicating a transformation into an aggressive phase.

REFERENCE


1.

Lee CK, Ma ES, Shek TW, et al. Plasmablastic transformation of multiple myeloma. Hum Pathol 2003 Jul;34(7):710–4. [CrossRef] [Pubmed]   Back to citation no. 1  

SUPPORTING INFORMATION


Author Contributions

Dong Hyang Kwon - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Bhaskar Kallakury - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guaranter of Submission

The corresponding author is the guarantor of submission.

Source Of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this clinical image.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2018 Dong Hyang Kwon et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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