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Plasma cell leukemia masquerading as ALL-L3--a case report
Kalpalata Tripathy1, Kalyani Prava Gouda, Sukumar Chakrabarty
1Department of Pathology, S. C.B. Medical College, Cuttack, Orissa.
Insights
Plasma cell leukemia (PCL) is a rare plasma cell disorder. This case highlights PCL presenting with over 80% atypical Mott cells, mimicking Acute Lymphoid Leukemia-L3, and confirmed by bone marrow, serum, and imaging findings.
Area of Science:
- Hematology
- Oncology
Background:
- Plasma cell leukemia (PCL) is an aggressive plasma cell dyscrasia characterized by over 20% circulating plasma cells.
- PCL is rare, often presenting with advanced disease and poor prognosis.
Observation:
- A 62-year-old female presented with a peripheral smear showing over 80% atypical vacuolated plasma cells (Mott cells).
- These cells morphologically mimicked Burkitt cells seen in Acute Lymphoid Leukemia-L3 (ALL-L3).
- Bone marrow aspirate showed few mature myeloma cells.
Findings:
- Serum protein electrophoresis revealed a positive M-band.
- Skeletal X-rays demonstrated lytic lesions in the femur and pelvic bones.
- A definitive diagnosis of PCL was established based on the combined clinical and laboratory findings.
Implications:
- This case underscores the importance of considering PCL in differential diagnoses, especially when atypical plasma cells are abundant.
- Morphological mimicry of ALL-L3 by Mott cells in PCL necessitates comprehensive diagnostic workup.
- Accurate diagnosis of PCL is crucial for appropriate treatment strategies and patient management.
Abstract:
Plasma cell leukemia (PCL) is a rare type of plasma cell dyscrasia. It is diagnosed when circulating plasma cells (PC) are more than 20%. We present a case of PCL in a 62-year-old female. Peripheral smear revealed more than 80% atypical vacuolated plasma cells (Mott cells) almost mimicking Burkitt cells of Acute Lymphoid Leukemia-L3 (ALL-L3). Bone marrow aspirate revealed few mature myeloma cells for which a diagnosis of PCL was thought of. Serum electrophoresis showed a positive M-band and X-ray revealed lytic lesions over femur & pelvic bones. A final diagnosis of PCL was given.