case_images: PMC10293938_01
case_images: Bone marrow aspiration and biopsy. a Hypercellular marrow (>90%), x100. b Atypical megakaryocytic hyperplasia (MDS) and atypical lymphoplasmacytic infiltrate (WM), x400. c MF-1 fibrosis, x400. d Atypical lymphoplasmacytic infiltrate is composed of CD20+ B cells, x400. e CD138-positive plasma cells, x400.
case_images: cro530328_f01.jpg
case_images: PMC10293938_01_cro530328_f01.jpg
case_images: F1
case_images: Her bone marrow aspiration and biopsy showed CD5-negative/CD10-negative low-grade B-cell lymphoproliferative disorder with plasmacytic differentiation, consistent with recurrent/persistent involvement by the patient's known WM (occupying approx. 50% of marrow's cellularity) (shown in Fig. 1).
case_images: Complete blood count over the course of the treatment.
case_images: cro530328_f02.jpg
case_images: PMC10293938_01_cro530328_f02.jpg
case_images: F2
case_images: Clinically, the patient was asymptomatic; her Hb normalized during the treatment course and remained stable at 14-15 gm/dL (shown in Fig. 2).
case_images: Post-treatment bone marrow aspiration and biopsy. a Hypercellular marrow for age (~50%), x100. b Normal megakaryocytes and scanty atypical lymphoplasmacytic infiltrate (~10%), x400. c MF-1 fibrosis, x400. d Atypical lymphoplasmacytic infiltrate is composed of CD79a+ B cells (~5%), x400. e CD138-positive plasma cells (~5%), x400.
case_images: cro530328_f03.jpg
case_images: PMC10293938_01_cro530328_f03.jpg
case_images: F3
case_images: The findings of hypercellularity, fibrosis, and persistence of similar complex cytogenetic abnormalities post-treatment with the same percentage (2 of 22 cells) supported that it is truly associated with a myeloid neoplasm, i.e., MDS in this case, and no evidence of a higher-grade process or progression was seen (shown in Fig. 3).