A case of CD138-/CD19+/CD4+ IgD plasma cell leukemia

Area of Science:

• Hematology
• Oncology
• Clinical Cytometry

Background:

• Plasma cell leukemia (PCL) is a rare and aggressive hematologic malignancy.
• It involves clonal proliferation of atypical plasma cells, sharing some features with multiple myeloma (MM).
• This report focuses on a unique IgD PCL case with an aberrant immunophenotype.

Observation:

• A 37-year-old patient presented with aggressive plasma cell dyscrasia.
• Peripheral blood and bone marrow samples were analyzed using morphology, flow cytometry, and immunohistochemistry.
• PCL diagnostic criteria were met based on peripheral blood analysis.

Findings:

• Flow cytometry and immunohistochemistry revealed a CD138-/CD38+/CD19+/CD4+/CD56-/CD117- phenotype.
• This immunophenotype is highly unusual for plasma cell leukemia.
• The cells were CD138 negative, CD19 positive, and CD4 positive.

Implications:

• Immunophenotyping is crucial for diagnosing challenging PCL cases.
• Atypical findings, such as the CD138-/CD19+/CD4+ phenotype, should not impede PCL diagnosis.
• Accurate diagnosis relies on integrating immunophenotypic data with clinical and morphological findings.