Help Joanne!

What is happening in this Cell?

“I would be most interested to get views from my colleagues on what is happening with this cell.” Joanne Melbourne, Deputy Lab. Manager Blood Sciences, University Hospital of Leicester, UK, wrote when she sent this unusual phenomenon to our blog.

The patient details are:
65 year old male
WBC count 14.3 x10^9/L
HB level 14.0 g/dL
PLTs 49 x10^9/L
previously diagnosed with CLL

The image was captured on a CellaVision DM96 at Leicester Royal Infirmary, UK.

The cell looks like this:

Help Joanne figure out what is happening here by sharing your views in the comments below.

20 thoughts on “Help Joanne!”

  1. It appears as though a portion of the nuclear material of the pro-lymphocyte has separated from the major nucleus by filament.

  2. We recently had a similar case. Clearly is a variant lymphocyte, most likely a prolymphocyte in a case of CLL. The significant feature not described by anyone else, is the nuclear material apparently “leaking” out of the nuclear and cytoplasmic membranes. Most smudge cell, commonly seen in CLL, will have both a ruptured cytoplasmic and nuclear membrane. The the case we had, as it appears in this case as well, the cytoplasmic membrane appears to remain intact and the nuclear membrane somehow fused to it creating a sort of “pore” for the nuclear material to “leak out”. We initially thought this was an artifact of the SP1000, but we saw the same phenomenon on hand-pulled smears. In 30 years, I have never seen this, and neither have the pathologists I discussed it with. Very interesting!

  3. It looks like a prolymphocyte in a mititic stage (like a phenomenon of bridging of normoblast)

  4. For Me regarding the age and the basic disease, and cell morphology, it is pre-b ALL, or turning to blastic crisis, whit punched nuclear lymphoid blast cells.

  5. we recently had a similar situation. a cll patient came in with the classic cll lymphs (80-90%) which turned reactive (almost all of them) in two days. he had been refusing chemo and had pneumonia.

  6. it’s hard to call it with just one cell. I need to see more cells.
    It looks like an abnormal/atypical lymphocyte.

  7. Suspect prolymphocyte, but would not make the identification on the basis of just one cell. The low PLT count is worrisome. What has the patient run previously?

  8. May be reactive or prolymphocyte but worrisome. ?cuurent viral infection? Knowing complete diferential would help, Need to exclude transformation of the CLL to large B cell lymphoma

  9. Could it be a mitotic cell captured right at the end of the cycle. Looks like an abnormal cell (lymphoma/Leukemia), so could have increased divisions, also hence the marked thrombocytopenia.

    1. I think Anthony is on the right track here. It looks like this malignant cell failed to fully separate during mitosis and the abnormal DNA is causing variation in the size and maturation of each daughter cell.

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