case_images: PMC9341343_01
case_images: Peripheral blood smear with immature mononuclear cells with a moderate blue cytoplasm, some of them suspicious for blasts (hematoxylin and eosin stain, X60).
case_images: autopsy-12-e2021393-g01.jpg
case_images: PMC9341343_01_autopsy-12-e2021393-g01.jpg
case_images: gf01
case_images: Bone marrow aspirate smear with some myeloblasts and immature cells suggestive of promyelocytes/ myelocytes but possibly representing blasts with atypical morphology. The picture also shows increased plasma cells (hematoxylin and eosin stain, 60X).
case_images: autopsy-12-e2021393-g02.jpg
case_images: PMC9341343_01_autopsy-12-e2021393-g02.jpg
case_images: gf02
case_images: There were additional 24% immature cells suggestive of promyelocytes but possibly representing blasts with atypical morphology (Figures 2A and 2B), and more than 10% dysplastic megakaryocytes (Figure 3). In addition, the bone marrow aspirate smear showed increased plasma cells (8% on manual differential count) (Figures 2A and 2B).
case_images: Bone marrow aspirate smear with a dysplastic megakaryocyte (arrow) (H&E, 40X).
case_images: autopsy-12-e2021393-g03.jpg
case_images: PMC9341343_01_autopsy-12-e2021393-g03.jpg
case_images: gf03
case_images: There were additional 24% immature cells suggestive of promyelocytes but possibly representing blasts with atypical morphology (Figures 2A and 2B), and more than 10% dysplastic megakaryocytes (Figure 3).
case_images: A - Hypercellular bone marrow core biopsy (~70% cellularity) (hematoxylin and eosin stain, 4 X); B - Bone marrow core biopsy immunohistochemistry for lambda shows increased lambda-restricted plasma cells (about 10% of cellularity) (10 X).
case_images: autopsy-12-e2021393-g04.jpg
case_images: PMC9341343_01_autopsy-12-e2021393-g04.jpg
case_images: gf04
case_images: Bone marrow core biopsy was hypercellular (70% of cellularity) (Figure 4A) with increased lambda-restricted plasma cells (about 10% of cellularity) (Figure 4B; immunohistochemistry for lambda).