I would like to solicit any and all opinions on the following case that we recently received in consultation. 75-year-old male with a peripheral blood lymphocytosis (WBC 14.5, atypical lymphocytes accounting for 95% of the cells), neutropenia, and macrocytic anemia (Hb 8.3, Hct 25, MCV 109.7). Patient is otherwise asymptomatic. Flow cytometry of the peripheral blood showed positivity for CD45 (dim), CD38 (dim), CD56, HLA-DR, intracytoplasmic CD19 and CD79a with kappa light-chain immunoglobulin restriction. Cells were negative for all T-cell markers and surface B-cell markers. Based on the flow findings we thought this was some type of terminally differentiated B-cell process (loss of surface B-cell markers, CD56, light-chain restriction, CD38), but the cells did not have a plasmacytoid or lymphoplasmacytoid appearance. Bone marrow had been subsequently obtained and showed sheets of intermediate to larger lymphoid cells with scant amounts of cytoplasm admixed with occasional plasma cells. Flow cytometrical analysis showed findings identical to that of the peripheral blood with the additional finding of CD13 and CD34 positivity. I have found the references where terminally differentiated B-cell processes can have aberrant myeloid antigen expression, but I have found nothing on CD34 positivity. Does anyone have any experience with a case such as this? Thanks! Jerry Myers JEROME B. MYERS, MD, PhD COL, MC Director, Pathology Residency Program Chief, Clinical Pathology Service Department of Pathology Madigan Army Medical Center Tacoma, WA 98431 Office (253)968-1723 Fax (253)968-1084
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