Reactive plasmacytosis with circulating plasma cells. Composite: blood (L) and bone marrow (R). This 71-year-old male was admitted because of fever (38.3ºC) and suspected cholangitis. Three years earlier he had a lobectomy because of pulmonary squamous cell carcinoma. Physical examination showed an enlarged liver, which was confirmed by ultrasonic investigation. The WBC was 15.4 ´ 109/ L with 10% plasma cells in the differential. A bone marrow aspirate showed about 30% small plasma cells with deep blue cytoplasm. There were no signs of carcinoma cell infiltration. A diagnosis of multiple myeloma with circulating plasma cells was considered. The total protein was not increased. The gamma globulin fraction was 40%. Agar electrophoresis revealed several monoclonal components. In the immunoelectrophoresis, the major component appeared to be a IgM-kappa paraprotein. The normal immunoglobulins were not decreased. Immunophenotyping of the blood plasma cells proved the polyclonality of these cells with a kappa/lambda ratio of 55/45. After treatment of the infection, plasma cells disappeared from the blood.

 

Polyclonal B cell lymphocytosis. Composite slide of a peripheral blood film from a 48-year-old asymptomatic woman with polyclonal B-cell lymphocytosis. Previous history was irrelevant except for heavy smoking. The cells are large, twice the size of a normal lymphocyte and have abundant pale cytoplasm and mature non-condensed chromatin. Some cells show a bi-lobed and/or deeply indented nucleus. Immunophenotype showed a polyclonal Bcell population FMC7+, CD19+, CD22+, CD5- with 40% lymphocytes staining with anti-lambda and 30% with anti-kappa. Cytogenetics and molecular analysis confirmed the polyclonal nature of the cells. Differential diagnosis includes “spill over” of B-cell non-Hodgkin’s lymphoma cells into the peripheral blood.

 

Neutrophilia. Four segmented and two band neutrophils are seen in this low-oil magnification view of the peripheral blood. Some red blood cells are slightly hypochromic.