Mystery cells, case #14

The laboratory at the Presbyterian/St.Lukes Medical Center in Denver, Colorado, USA, came across this unusual patient case in their Body Fluid Application on CellaVision DM96.

A young female (oncology patient) came to the hospital for treatment which included a spinal fluid aspiration. The spinal fluid sample was brought to the laboratory and a cytocentrifuge preparation was completed. The sample slide was stained with Wright Giemsa stain.

Below you can see some of the cells that the lab found on their Body Fluid Application on CellaVision DM96.

What do you think of the cells and the woman’s condition!

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24 thoughts on “Mystery cells, case #14”

  1. I think these cells are non-hematopoietic malignant (tumor) cells. Probably of a metastatic breast/adenoma carcinoma.

  2. I think these are non-haemopoetic and probably metastatic cancer cells. The irregular outline could be due to damage during centrifugation of the sample.

  3. It’s hard to tell what kind of cells these are, maybe malignant cells, however, the “blebs” on the periphery of the cytoplasm might be an artifact from the cytocentrifuge prep.

  4. Considering the patient is from Oncology clinic, for an accurate clasiffication of this cells we need Flow Cytometry study in this CSF. She may have CNS involvement of her condition. Cell #194244( ( by morphology) resembles a macrophage with a cell inside, cell #194343 and 194389 has projections in cytoplasm that could be any pleomorphic lymphoma or either a blast cell. By morphology clasiffication only is very difficult to know exactly what kind of cells are these.

  5. I would like to know more rgarding patient’s history, and reason for spinal fluid collection. The cells appear to be non-hematopoietic abnormal/malignat cells.

  6. The morphology suggests Hairy Cell Lymphoma, but it is unlikely for this patient because of age and gender (the median age for HCL is around 50, and it affects mostly men). Acute lymphoblastic leukaemia is a possibility because of the infiltration to CSF, but these cells are not blasts, which makes this diagnosis unlikely. However, the irregular nuclear border suggests an underlying malignancy. It is very likely to be a lymphoma. Based on the size of these cells, Diffuse Large B Cell Lymphoma (DLBCL) is a possibility. Also, primary lymphoma of the nervous system can be considered as a differential diagnosis. Metastesis from other primary tumours can not be excluded, but the morphology of these cells suggests a lymphoid disorder.

  7. I think the atypical cytoplasm appearance is an artifact due to the cytospin prep. The cells may be malignant, hard to tell.

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