International Journal of Case Reports and Images, Vol. 9, 2018. ISSN: 0976-3198

Int J Case Rep Images 2018;9:100959Z01DK2018. www.ijcasereportsandimages.com

Kwon et al. 1

CLINICAL IMAGE PEER REVIEWED | OPEN ACCESS

Acute plasmablastic leukemia – A diagnostic challenge

Dong Hyang Kwon, Bhaskar Kallakury

CASE REPORT

A 58-year-old male with myeloma treated with chemotherapy and bone marrow transplant presented with thrombocytopenia and anemia. A peripheral blood smear showed numerous blast-like cells (30%), some with subtle plasmacytoid morphology (Figure 1 - Panel A). Flow cytometry analysis showed variable expression of CD38, CD56 and cytoplasmic kappa-restriction (Figure 1 - Panel B, C, D). Due to negativity for CD138, an innovative approach of cell block preparation from peripheral leukocyte pellet was attempted and demonstrated positivity for MUM1 (Figure 1 - Panel E). Following a diagnosis of plasmablastic leukemia, a bone marrow aspirate showed mostly undifferentiated blastic cells (90%) (Figure 1 - Panel F) with the same phenotype noted above (biopsy not performed). These findings confirmed plasmablastic myeloma presenting as plasmablastic leukemia. The patient expired within 6 months of above diagnosis.

DISCUSSION

Blastic cells in peripheral blood with subtle plasmacytoid morphology raise a broad differential diagnosis including acute leukemia and leukemic phase of myeloma, plasmablastic lymphoma and other non-Hodgkin’s lymphomas. Plasma cell leukemia in itself is infrequent but presentation with plasmablasts of this degree in the peripheral blood is rare. Plasmablasts can

Dong Hyang Kwon1, Bhaskar Kallakury2

Affiliations: 1Senior Resident Physician, Department of Pa-thology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington DC, USA; 2Professor, De-partment of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington DC, USA.Corresponding Author: Dong Hyang Kwon, MD, George-town University Hospital, Pathology, 3900 Reservoir Rd NW Med Dent Building 2nd floor, SW 201, Washington DC, USA; Email: Donghyang.kwon@gunet.georgetown.edu

Received: 13 September 2018Accepted: 08 October 2018Published: 26 October 2018

involve blood as terminal phase of myeloma [1] and this stage may deserve the designation of acute plasmablastic leukemia.

CONCLUSION

This is a rare presentation of plasmablasts in peripheral blood of a patient with multiple myeloma indicating a transformation into an aggressive phase.

REFERENCES

1. Lee CK, Ma ES, Shek TW, et al. Plasmablastic transformation of multiple myeloma. Hum Pathol 2003 Jul;34(7):710–4.

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Keywords: Myeloma, Plasmablastic leukemia, Plas-mablastic myeloma

Figure 1: (A) Peripheral blood smear showing blasts with plasmacytoid morphology [1000x, Giemsa stain]; (B, C, D) Flow cytometry analysis showing kappa-restricted tumor cells to be positive for CD38 and CD56, confirming plasmacytic differentiation; (E) Tumor cells show immunoreactivity to MUM1 [400x, IHC stain for MUM1]; (F) Bone marrow aspirate showing blasts with similar plasmacytoid morphology.

International Journal of Case Reports and Images, Vol. 9, 2018. ISSN: 0976-3198

Int J Case Rep Images 2018;9:100959Z01DK2018. www.ijcasereportsandimages.com

Kwon et al. 2

How to cite this article

Kwon DH, Kallakury B. Acute plasmablastic leukemia – A diagnostic challenge. Int J Case Rep Images 2018;9:100959Z01DK2018.

Article ID: 100959Z01DK2018

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doi: 10.5348/100959Z01DK2018CL

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AcknowledgementsThe authors would like to acknowledge Ariel C Viramontes, MD for assisting in creating the image panel.

Author ContributionsDong Hyang Kwon – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be publishedBhaskar Kallakury – Substantial contributions to conception and design, Acquisition of data, Analysis

and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guarantor of SubmissionThe corresponding author is the guarantor of submission.

Source of SupportNone.

Consent StatementWritten informed consent was obtained from the patient for publication of this clinical image.

Conflict of InterestAuthors declare no conflict of interest.

Data AvailabilityAll relevant data are within the paper and its Supporting Information files.

Copyright© 2018 Dong Hyang Kwon et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.

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