Cell Case #24

A 83-year old man was admitted to the emergency ward because of aberrant laboratory results during a routine check-up after a recent gastric bleeding.

Hemoglobin: 10,3 g/dL
Thrombocyte count: 100×109/L
Leukocyte count: 250×109/L

Peripheral blood smear analysis revealed the following lymphocytes:

What is your diagnosis? Please post your suggestions.

NEW! Download Cell Case #24 as pdf and share with your colleagues. Click here>>

/ The CellaVision Blog Team

About the CellaVision Blog

This blog is created by CellaVision for laboratory professionals with a particular interest in hematology and digital cell morphology. Our aim is to inform, educate and inspire in equal measures – by highlighting interesting articles, sharing interesting patient cases and cell images, and presenting inspiring success stories from our community of CellaVision-users from around the world.


37 thoughts on “Cell Case #24”

  1. These cells are large and blastic, could either be an acute leukemia or a blastic mantle cell in the periphery.

  2. Prolinfocytic leukemia B cells (B-PLL) is a very rare B-cell neoplasm composed of so-called prolymphocytes, typically involving peripheral blood, bone marrow and spleen. The name “prolinfocito” is actually an inappropriate name, since the tumor cells in this disease are mature activated B cells. By definition, these prolymphocytes comprise more than 55 percent of the cells in the blood and look for.
    B-PLL is an extremely rare disease, accounting for less than 1 percent of B cell leukemias. Since the diagnosis was changed to exclude cases of mantle cell lymphoma, atypical chronic lymphocytic leukemia (CLL), and CLL / PLL (defined as between 15 and 55 percent prolymphocytes), B-PLL has become increasingly rare.
    B-PLL mainly affects the elderly with a mean age of presentation between 65 and 70 years.
    Patients typically present with a rapidly increasing white blood cell count of> 100,000 / microliter and massive splenomegaly; Anemia and thrombocytopenia are present in approximately 65 and 35 percent, respectively. Systemic B symptoms (ie, fever, night sweats, weight loss) are common.

  3. Células B de leucemia prolinfocítica (B-PLL) es un neoplasma de células B muy raro compuesto de los llamados prolinfocitos, típicamente con implicación de la sangre periférica, médula ósea y el bazo. El nombre “prolinfocito” es en realidad un nombre inapropiado, ya que las células tumorales en esta enfermedad son células B activadas maduros. Por definición, estos prolinfocitos comprenden más de 55 por ciento de las células en la sangre y busque.
    B-PLL es una enfermedad extremadamente rara, que comprende menos del 1 por ciento de las leucemias de células B .Desde el diagnóstico fue cambiado a excluir los casos de linfoma de células del manto, atípico leucemia linfocítica crónica (CLL), y CLL / PLL (definido como entre 15 y el 55 por ciento prolinfocitos), B-PLL se ha convertido cada vez más raro.
    B-PLL afecta principalmente a los ancianos con una edad media de presentación de entre 65 y 70 años.
    Los pacientes típicamente se presentan con un recuento de glóbulos blancos rápido aumento de> 100.000 / microlitro y esplenomegalia masiva; anemia y trombocitopenia están presentes en aproximadamente el 65 y 35 por ciento, respectivamente. Los síntomas sistémicos B (es decir, fiebre, sudores nocturnos, pérdida de peso) son comunes

    1. Efectivamente, es un Lymphoma de células B Difuso.Concuerda con el sangrado gástrico.

  4. Aggressive looking cells differential acute leukaemia vs aggressive lymphoma needs immunophenotype for diagnosis

  5. Certainly a case that emphasises the need to view cells in context and to remember that “the company cells keep” can be an important factor (snapshot images can be dangerously misleading). Immunophenotyping and cytogenetics/molecular studies would be needed too, but these large, nucleolated, moderate-to-high N:C ratio ‘lymphoid’ cells (according to the strapline), with often irregular nuclear outlines, give me the feeling of a lymphoma or possibly a previous condition transforming to a lymphoma such as a Richter’s transformation showing DLBCL features. The two large, irregular cells don’t suggest prolymphocyte origin to me, but it will be interesting to see the final diagnosis. Either way, interesting case!

  6. This appears to be a blast or lymphoma cell. There appears to be a huge nucleoli at 3:00 o’clock.

  7. Definitely an acute leukemia.
    Need further studies to confirm lineage.
    Suspect ALL or Monoblastic

  8. I believe the cells are blast cells
    It may be myelo- og lymphoblasts, however they look a little monocytic to me.
    My guess is Monoblastic leukemia type M5a, but it needs confirmation.

Comment on this blogpost

Your email address will not be published. Required fields are marked *


I confirm that I have read and accept Membership Terms & Conditions and CellaVision’s Privacy Policy

I give CellaVision permission to contact me about other things not directly related to my membership

Do you have an interesting story to share?