case_images: PMC11380119_01
case_images: (A) Wright-Giemsa stained of bone marrow aspirate smear showing intact hematopoiesis with plasmacytosis (white arrows; 50x). Plasma cells are highlighted by CD138 IHC 40x magnification (B). The plasma cells are polytypic for Kappa-IHC (C) and Lambda-IHC (D), 40x magnification.
case_images: 10.1177_2632010X241278180-fig1.jpg
case_images: PMC11380119_01_10.1177_2632010X241278180-fig1.jpg
case_images: fig1-2632010X241278180
case_images: The bone marrow aspirate showed normal trilineal hematopoiesis and a marked increase in polytypic plasma cells (~31%; Figure 1A-D).
case_images: Slides from the trephine bone marrow core biopsy (case 1). (A) 40x magnification of H&E demonstrating increased lymphoblasts as noted by yellow arrows 100x oil immersion magnification (B). (C) Flow cytometry images showing the blasts are CD45 dim, expressing CD19, CD10, and TDT. Peripheral blood and bone marrow of case 2. (D) peripheral blood smear 40X showing pancytopenia with circulating blasts. (E) touch prep 40x showing increased sheets of blasts highlighted by Pax-5 (F) 40X and TDT (G) 40X.
case_images: 10.1177_2632010X241278180-fig2.jpg
case_images: PMC11380119_02_10.1177_2632010X241278180-fig2.jpg
case_images: fig2-2632010X241278180
case_images: The CBC showed normocytic anemia (Hb: 8.3 g/dL), leukopenia (0.6 x 103/mL) with marked neutropenia (absolute neutrophil count of 0.1) thrombocytopenia (23 K/mm3), and circulating blasts (Figure 2D). A bone marrow examination was performed showing aplastic trilineage hematopoeisis with increased blasts (Figure 2E) with a B-ALL immunophenotype, PAX5+/TDT+ (Figure 2F and G)/CD34+ (not shown).
case_images: PMC11380119_02
case_images: Slides from the trephine bone marrow core biopsy (case 1). (A) 40x magnification of H&E demonstrating increased lymphoblasts as noted by yellow arrows 100x oil immersion magnification (B). (C) Flow cytometry images showing the blasts are CD45 dim, expressing CD19, CD10, and TDT. Peripheral blood and bone marrow of case 2. (D) peripheral blood smear 40X showing pancytopenia with circulating blasts. (E) touch prep 40x showing increased sheets of blasts highlighted by Pax-5 (F) 40X and TDT (G) 40X.
case_images: 10.1177_2632010X241278180-fig2.jpg
case_images: PMC11380119_02_10.1177_2632010X241278180-fig2.jpg
case_images: fig2-2632010X241278180
case_images: The CBC showed normocytic anemia (Hb: 8.3 g/dL), leukopenia (0.6 x 103/mL) with marked neutropenia (absolute neutrophil count of 0.1) thrombocytopenia (23 K/mm3), and circulating blasts (Figure 2D). A bone marrow examination was performed showing aplastic trilineage hematopoeisis with increased blasts (Figure 2E) with a B-ALL immunophenotype, PAX5+/TDT+ (Figure 2F and G)/CD34+ (not shown).