This interesting mystery cells case is presented by Margit Grome, Biomedical Laboratory Scientist, Department of Clinical Biochemistry at Rigshospitalet, Copenhagen University Hospital.
Here are the patient details:
A 4 year-old boy, hospitalized at the Department of Paediatrics.
Cell count at the Sysmex XE-2100 showed, click to enlarge.
The Sysmex XE-2100 could not perform a differential count but gave the alarm:
“Atypical Lympho ? and Abn Lympho/L_Blasts?”
We validated 400 cells in the CellaVision DM96. We were a bit surprised to see 10% of – rather immature looking – mononuclear cells.
Click to enlarge the cells.
What diagnosis do you suspect? Discuss with your colleagues and share your thoughts about the cell types and what possible diagnosis it could be.
The diagnosis will be posted next Wednesday.
I deem those cells in row 4 are activated T lymphocytes,their cytoplasm looks like the one’s of plasma cell,but their chromatin don’t look like the one’s of plasma cell,their chromatin seems looser.
option 1-could be plasmocytoid cells.
2-could be megakaryocytic bits.
The 10% looked like the cells in row 3 !
Sorry – it is of course row 4.
This appears to be a reactive lymphocytosis and most likely Infectious Mononucleosis
immature plasma cell
instrument is counting it as basophil.
diagnosis could be…plasmacytic leukemia(acute) 10% on a 4 yr. old boy.
I believe these cells are plasmacytoid B-Lymphocytes, they might be a response bacterial infection.
I dont consider them immature, since the chromatinstructure of the is rather coarse.
I agree, that what is counted as basophils, is actually activated lymphocytes.
Also these reactive lymphocytes are counted as basophils on the XE2100.
Glandular fever. The reactive lymphocytes in row 4 are typical of those seen in inf. mono.