case_images: PMC4272948_01
case_images: Histologic findings of the bone marrow biopsy. (A) Bone marrow biopsy showed nodular lymphocytic infiltrates with malignant cells (Hematoxylin and Eosin, x400). (B) The malignant cells were positive for CD3 (x400). (C, D) Plasma cells expressed kappa light chain restriction. Immunohistochemical staining with anti-kappa (C) and anti-lambda (D) (x400).
case_images: alm-35-149-g001.jpg
case_images: PMC4272948_01_alm-35-149-g001.jpg
case_images: F1
case_images: T-cells and diffuse CD138+ clonal plasma cells at proportions of 10% and 30%, respectively (Fig. 1). The CD3+ T-cells were medium-sized lymphoid cells with moderate amounts of clear cytoplasm and slightly indented nuclei with coarse and condensed chromatin.
case_images: Flow cytometry analysis of circulating lymphocytes. (A) and (B) CD45 and side scatter (SSC) gating: T-cells were positive for CD3, and B-cells were positive for CD19. (C) and (D) The CD19+ B-cells expressed high density of CD38 and cytoplasmic monoclonal immunoglobulin light chain kappa proteins suggestive of plasma cells. (E) and (F) CD3+ T-cells were negative for CD7 and positive for CD4 suggesting the presence of malignant T-cells with immunophenotypic variation.. Abbreviations: SSC, side scatter; cKAPPA, cytoplasmic immunoglobulin kappa; cLAMBDA, cytoplasmic immunoglobulin lambda.
case_images: alm-35-149-g002.jpg
case_images: PMC4272948_01_alm-35-149-g002.jpg
case_images: F2
case_images: Representative scatter plots of the immunophenotypic findings obtained from the flow cytometry analysis are shown in Fig. 2.