Color Atlas of Hematology - Practical Microscopic and Clinical ...

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84Abnormalities of the White Cell SeriesVariability of Plasmacytoma MorphologyIt is not easy to visually distinguish malignant cells from normal plasmacells. Like lymphocytes, normal plasma cells have a densely structured nucleus.Plasma cell nuclei with radial chromatin organization, known as“wheel-spoke nuclei,” are mostly seen during histological analysis.The following attributes suggest a malignant character of plasma cells:the cells are unusually large (Fig. 28 c), they contain crystalline inclusionsor protein inclusions (“Russell bodies”) (Fig. 28 b), or they have more thanone nucleus (Fig. 28 c).In the differential diagnosis, they must be distinguished from hematopoieticprecursor cells (Fig. 28 d), osteoblasts (Fig. 20 c), and blasts in acuteleukemias (see Fig. 31, p. 97).Bone marrow involvement may be focal or in rare cases even solitary.Aside from cytological tests, bone marrow histology assays are thereforeindicated. Sometimes, the biopsy must be obtained from a clearly identifiedosteolytic region.Although plasmacytomas progress slowly, staging criteria are available(staging according to Salmon and Durie) (Table 11).Therapy may be put on hold in stage I. Smoldering indolent myelomacan be left for a considerable time without the introduction of therapystress. However, chemotherapy is indicated once the myeloma hasexceeded the stage 1 criteria.Table 11Staging of plasmacytomas according to Salmon and DurieStage IAll the following are present:– Hb 10 g/dl– Serum calcium is normal– X-ray shows normal bone structureor solitary skeletal plasmacytoma– IgG 5 g/dl*IgA 3 g/dl*Light chains in the urine* 4 g/24 h* Monoclonal in each case.Stage IIFindings fulfill neither stage I norstage III criteriaStage IIIOne or more of the following arepresent:– Hb 8.5 g/dl– Serum calcium is elevated– X-ray shows advanced bone lesions– IgG 7 g/dl*IgA 5 g/dl*Light chains in the urine: 12 g/24 h
Atypias and differential diagnoses of multiple myelomaabcdFig. 28 Atypical cells in multiple myeloma. a Extensive infiltration of the bonemarrow by loosely structured, slightly dedifferentiated plasma cells with wide cytoplasmin multiple myeloma. b In multiple myeloma, vacuolated cytoplasmicprotein precipitates (Russell bodies) may be seen in plasma cells but are withoutdiagnostic significance. c Binuclear plasma cells are frequently observed in multiplemyeloma (1). Mitotic red cell precursor (2). d Differential diagnosis: red cellprecursor cells can sometimes look like plasma cells. Proerythroblast (1) and basophilicerythroblast (2).85
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iiiColor Atlas of HematologyPractic
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vPrefaceOur Current EditionAlthough
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viiContentsPhysiology and Pathophys
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ContentsixAcute Lymphoblastic Leuke
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2Physiology and Pathophysiology of
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Normal Cells of the Blood andHemato
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Normally erythropoiesis takes place
Page 44 and 45: 34Normal Cells of the Blood and Hem
Page 49 and 50: Advancing nuclear contraction and s
Page 51: Note the granulations, inclusions,
Page 71 and 72: Abnormalities of the White Cell Ser
Page 73 and 74: Predominance of Mononuclear Round t
Page 77 and 78: During lymphatic reactive states, v
Page 79 and 80: Extreme transformation of lymphocyt
Page 85 and 86: Monotonous proliferation of small l
Page 87 and 88: Atypical lymphocytes are not part o
Page 89 and 90: Deep nuclear indentation suggests f
Page 91 and 92: Cytoplasmic processes the main feat
Page 93: Plasmacytoma cannot be diagnosed wi
Page 97 and 98: Bone marrow diagnosis is indicated
Page 99 and 100: Conspicuously large numbers of mono
Page 107 and 108: Fundamental characteristic of acute
Page 109 and 110: The diagnosis of acute leukemia is
Page 111 and 112: Acute leukemias may also derive fro
Page 113 and 114: New WHO classification: AML with dy
Page 115 and 116: The cells in acute lymphocytic leuk
Page 117 and 118: In unexplained anemia and/or leukoc
Page 119 and 120: The classification of myelodysplasi
Page 121 and 122: Prevalence of Polynuclear (Segmente
Page 123 and 124: Predominance of the granulocytic li
Page 125 and 126: Prevalence of Polynuclear (Segmente
Page 127 and 128: Left shift as far as myeloblasts, p
Page 129 and 130: Bone marrow analysis is not obligat
Page 131 and 132: In the course of chronic myeloid le
Page 133 and 134: Enlarged spleen and presence of imm
Page 135 and 136: Eosinophilia and basophilia are usu
Page 137 and 138: Erythrocyte and ThrombocyteAbnormal
Page 139 and 140: Hypochromic Anemias129Insufficient
Page 141 and 142: Hypochromic Anemias131BSGIron Ferri
Page 143 and 144: Small, hemoglobin-poor erythrocytes
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Hypochromic erythrocytes of very va
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Hypochromic Anemias137Hypochromic S
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Hypochromic anemia without iron def
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Consistently elevated “young” e
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Distribution pattern and shape of e
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Conspicuous erythrocyte morphology
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Unexplained decrease in cell counts
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Hypochromic Anemias149Differential
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Thrombocytopenia with leukocytosis
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Conspicuous large erythrocytes sugg
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In older patients, myelodysplastic
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Small inclusions are usually a sign
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PlasmodiumfalciparumPlasmodiumvivax
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Conspicuous erythrocyte inclusions
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Bone marrow analysis contributes to
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Thrombocytes: increases, reductions
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Thrombocytes: increases, reductions
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Variant forms of thrombocyte and me
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Thrombocyte proliferation with larg
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Cytology of Organ Biopsiesand Exuda
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Lymph Node Cytology175Anamnesis- su
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Reactive lymph node hyperplasia and
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Lymph Node Cytology179Contact witha
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Epithelioid cells dominate the lymp
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In cases of non-Hodgkin lymphoma an
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Accessible cysts (e.g., branchial c
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Tumor cells can be identified in pl
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Viral, bacterial, and malignant men
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191IndexAActinomycosis 179Addison d
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Index193Disseminated intravascularc
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Index195blast crisis 120-121bone ma
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Index197in hemolytic anemia 140orth
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