This case presents a 60 year old male that came to the hospital with abdominal pain, pain in the neck and armpits and sore throat. He also suffered from night sweats and fever.
What are your thoughts about the man’s condition?
Click to enlarge the cells.
I like to identify these slides. Let me start from top left.
1)Eosinophil
2)Lymphocyte
3)monocyte
4)Neutrophil
5)Monocyte
6)Monocytes
7)Monocytes
8)Atypical lymphocyte
9)Atypical lymphocyte.
how you sure about the cells. if look to me like cells #5 to #9 were Atypical/reactive lymphocyte. this is a lymphoma case do u think.
The clinical details scream out “Lymphoma”, and apart from the Eosinophil, neutrophil and small lymphocyte, the appearance of the cells range from a monocyte through large mononuclear to abnormal lymphocyte, with convoluted nucleus and scalloped cell margins where they meet the red cells still supports probable t cell lymphoma.
i need CBC and i think that these cells are hystiocyte and it may be a hystyocyte lymphoma.
I think it’s infectious mononucleosis. If EBV serology excludes that, then suggest cell markers for T-cell lymphoma.
I also thinks this looks like a lymphoma.
atypical lymphocyte
I think it is a T-cell lymphoma due to the pleomorphic looking lymphocytes with prominent nucleoi.
Without the FBC results it is hard to make a diagnosis, and flow cytometry results would also be necessary for a final diagnosis.
I may be crazy, but these look like Sezary cells to me. They can accompany lympadenopathy, and can be associated with Sezary syndrome, cutaneous lymphoma, HIV (fever, night sweats).
lymphoma
More information from the CBC and other lab tests are needed to decide on what these cells could be. Morphologists are GREAT but associated information will help with the decision as what else to do next. Or at least that is my approach.
If based on these photos alone, they look too large for reactive lymphs. They do have the monocytoid and blast-like look. They also have the look of bizarre lymphs in lymphomas.
I am anxious to see the results next week. Would you please provide the whole CBC along with other labs results that help with the diagnosis of this case? Thank you!
I vote for lymphoma with the large atypical lymphoctes – especially the last one with a deep nuclear cleft. This correlates with enlarged lymph node pain and fever.
I think that the blood film shows a case of Non Hodgkins lymphoma. This clinical details would indicate this, but the presence of atypical mononuclear cells does also suggest Infectious mononucleosis. Further tests would be required to differentiate the conditions.
I think the patient suffers from lymfoma. Based on the morfology of atypical lymfosytes. Does not seem like viral reactive lymfosytes.
lymphoma not lymfoma
Based on both the clinical information and the morphology of the white cells, I think this is a case of infectious mononucleosis. The CBC test and screen test (e.g. Mono test) should be done.
I agree
Unusual in a patient this age but I think it is Infectious mononucleosis not lymphoma. The record age for inf. mono in our lab is 88!!
If me,
1) first i will go for Infectious mononucleosis. The reason is because the patient suffering
from neck and armpit pain; this is probably due to lymphadenopathy which can be seen in viral infection.
The morphology feature shows atypical lymphocytes/reactive lymphocytes which can be seen in viral
infection too. The eosinophils and monocytes doesnt give much information.
2) Secondly im also thinking of non hodgkin’s lymphoma just because of the bizarre looking lymphocytes.
May be there are slight increase in eosinophils which support the NHL.
3) Thirdly im thinkig of myelodysplastic syndrome (MDS) just because of the bizarre looking lymphocytes
which could be an abnormal blast cells and associated with agranulocytic neutrophils.
Hope to see the final results soon. thank you.
Considering the age and given symptoms for this patient, and the appearance of the cells, they most likely are the result of a lymphoma. Further workup is indicated.
Large mononuclear cells with high nuclear cytoplasmic ratio and immature chromatin (one may have a nucleolus and looks blastic). Suggestion of rbc rosetting of some of these cells may indicate surface Ig – Large B-cell Lymphoma needs to be ruled out.
I think that is a monunucleosis syndrome. aditional laboratory test TORCH
Peripheral T-cell Lymphoma,unspecified
Think Lymphoma
This is a case of infectious mononucleosis caused by Ebstein-Barr virus.
Indeed based on clinical information and abnormal morphology of the lymphocytes, I think it’s some kind of lymphoma
I think it’s some kind of lymphoma
Given the patients age, history and the abnormal lymphoid cells, lymphoma would seem to be the most likely diagnosis. At least one of the lymphoid cells has nuclear clefting and open chromatin. A IM screen test should be done to discount IM. FBC results would be useful in this case.
Infectious Mono
I think lymphoid leukemia
Based on the symptoms and cell picture that the patient presents, I would perform further work-up to investigate the probable diagnosis of lymphoma and to rule out mononucleosis.
I agree with Cierra
The cells look like reactive lymphs, but with the age and symptoms of the patient, more testing is needed. It would be helpful to have a WBC and RBC count.
Given this patient’s age, clinical history and the young looking lymhs, I too believe this is non-hodgkins lymphoma.
With the symptoms displayed by the patient, I would want follow-up testing to rule out lymphoma (lymph node pain under arms?).
Lymphoma
Mononucleosis
I think he is suffering from some form of Lymphoma.
Flowcytometry should be ordered for confiramtion.
I think it is lymphoma
Patient has Mononucleosis.
Patient has Mononucleosis
I think it is lymphoma.
Non-Hogkins lymphoma…
I think it could be a reactive reaction to some virus(Epstein Barr) for example.
Lymphoma
Based on both the clinical information and the morphology of the cells, I would guess that this man is suffering from some kind of lymphoma.