2012-01-11

Mystery cells, case #6

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.

38 thoughts on “Mystery cells, case #6”

  1. 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.

  2. 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).

  3. 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.

  4. 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.

  5. I think the patient suffers from lymfoma. Based on the morfology of atypical lymfosytes. Does not seem like viral reactive lymfosytes.

  6. 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!!

  7. 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.

  8. 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.

  9. 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.

  10. Indeed based on clinical information and abnormal morphology of the lymphocytes, I think it’s some kind of lymphoma

  11. 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.

  12. 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.

  13. 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.

  14. With the symptoms displayed by the patient, I would want follow-up testing to rule out lymphoma (lymph node pain under arms?).

  15. 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.

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